Nonmyeloablative allogeneic hematopoietic stem cell transplantation as immunotherapy for pancreatic cancer.

Abstract

OBJECTIVE:

Advanced unresectable pancreatic cancer has an extremely poor prognosis despite intensive chemotherapy. As a new therapeutic modality, we investigated nonmyeloablative allogeneic hematopoietic stem cell transplantation from a related donor.

METHODS:

Five patients with chemotherapy-resistant pancreatic cancer received allogeneic peripheral blood stem cell transplantation after a conditioning regimen consisting of low-dose total body irradiation and fludarabine. The prophylaxis for graft-versus-host disease consisted of mycophenolate mofetil and cyclosporine.

RESULTS:

The median age of the 5 patients was 54 years, and the median duration from diagnosis to nonmyeloablative allogeneic hematopoietic stem cell transplantation was 10 months. Three of the 5 patients achieved complete donor chimerism of peripheral T cells, at a median time of day 42. Acute graft-versus-host disease developed in 3 patients: grade 2 in 2 patients and grade 1 in 1. Tumor reduction was observed in 2 patients: 1 patient showed disappearance of the pancreatic tumor, and the other patient showed approximately 20% reduction of the tumor. Marked elevation of tumor necrosis factor alpha was observed as the tumor regressed.

CONCLUSIONS:

Although advanced pancreatic cancer progresses rapidly, some graft-versus-tumor effects and pivotal role of tumor necrosis factor alpha were suggested. To obtain the durable response, patient selection and new strategies become important.

• Authors: Yasunobu Abe, Tetsuhide Ito, Eishi Baba, Koji Nagafuji, Ken Kawabe, Ilseung Choi, Yoshiyuki Arita, Toshihiro Miyamoto, Takanori Teshima, Shuji Nakano, Mine Harada
• Journal: Pancreas (Pancreas) Vol. 38 Issue 7 Pg. 815-9 (Oct 2009) ISSN: 1536-4828 [Electronic] United States
• PMID: 19696692 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antineoplastic Agents
• Tumor Necrosis Factor-alpha
• Cyclosporine
• Vidarabine
• Mycophenolic Acid
• fludarabine

Topics

• Adult
• Antineoplastic Agents (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cyclosporine (administration & dosage)
• Female
• Graft vs Host Disease (metabolism, prevention & control)
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Immunotherapy (methods)
• Male
• Middle Aged
• Mycophenolic Acid (administration & dosage, analogs & derivatives)
• Pancreatic Neoplasms (therapy)
• Time Factors
• Transplantation Conditioning
• Transplantation, Homologous
• Tumor Necrosis Factor-alpha (metabolism)
• Vidarabine (administration & dosage, analogs & derivatives)
• Whole-Body Irradiation