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Annals of Oncology Advance Access originally published online on April 28, 2006
Annals of Oncology 2006 17(7):1134-1140; doi:10.1093/annonc/mdl086
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© 2006 European Society for Medical Oncology

Allogeneic haematopoietic stem cell transplantation for metastatic renal carcinoma in Europe

L. Barkholt1,*, M. Bregni2, M. Remberger1, D. Blaise3, J. Peccatori2, G. Massenkeil4, P. Pedrazzoli5, A. Zambelli6, J.-O. Bay7, S. Francois8, R. Martino9, C. Bengala10, M. Brune11, S. Lenhoff12, A. Porcellini13, M. Falda14, S. Siena5, T. Demirer15, D. Niederwieser16, O. Ringdén1 On behalf of the French ITAC group and the EBMT Solid Tumour Working Party

1 Division of Clinical Immunology and Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden; 2 Istituto Scientifico H.S. Raffaele, Milan, Italy; 3 Institut Paoli Calmettes, Marseille, France; 4 Hospital Charité, Berlin, Germany; 5 Ospedale Niguarda Ca' Granda, Milan, Italy; 6 Fondazione S. Maugeri, Pavia, Italy; 7 Centre Jean Perrin-CHU, Clermont Ferrand, France; 8 CHRU Angers, France; 9 Hospital Santa Creu I Sant Pau, Barcelona, Spain; 10 St. Chiara University Hospital, Pisa, Italy; 11 Sahlgrenska University Hospital, Gothenburg, Sweden; 12 Lund University Hospital, Lund, Sweden; 13 Departimento di Oncologia/Ematologia, Ospedale P.F. Calvi Noale, Italy; 14 Azienda Ospedaliera S. Giovanni, Torino, Italy; 15 Ankara University Medical School, Ankara, Turkey; 16 University Hospital Leipzig, Leipzig, Germany

* Correspondence to: Dr L. Barkholt, Associate Professor, Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Karolinska Institutet, SE-141 86 Stockholm, Sweden. Tel: +46 8 585 80000; Fax: +46 8 585 87870; E-mail: lisbeth.barkholt{at}karolinska.se

Background: An allogeneic antitumour effect has been reported for various cancers. We evaluated the experience of allogeneic haematopoietic stem cell transplantation (HSCT) for renal cell carcinoma (RCC) in 124 patients from 21 European centres.

Patients and methods: Reduced intensity conditioning and peripheral blood stem cells from an HLA-identical sibling (n = 106), a mismatched related (n = 5), or an unrelated (n = 13) donor were used. Immunosuppression was cyclosporine alone, or combined with methotrexate or mycophenolate mofetil. Donor lymphocyte infusions (DLI) were given to 42 patients. The median follow-up was 15 (range 3–41) months.

Results: All but three patients engrafted. The cumulative incidence of moderate to severe, grades II–IV acute GVHD was 40% and for chronic GVHD it was 33%. Transplant-related mortality was 16% at one year. Complete (n = 4) or partial (n = 24) responses, median 150 (range 42–600) days post-transplant, were associated with time from diagnosis to HSCT, mismatched donor and acute GVHD II-IV. Factors associated with survival included chronic GVHD (hazards ratio, HR 4.12, P < 0.001), DLI (HR 3.39, P < 0.001), <3 metastatic sites (HR 2.61, P = 0.002) and a Karnofsky score >70 (HR 2.33, P = 0.03). Patients (n = 17) with chronic GVHD and given DLI had a 2-year survival of 70%.

Conclusion: Patients with metastatic RCC, less than three metastatic locations and a Karnofsky score >70% can be considered for HSCT. Posttransplant DLI and limited chronic GVHD improved the patient survival.

Key words: allogeneic stem cell transplantation, antitumour effect, reduced intensity conditioning, renal cell carcinoma


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