Mismatched Stem Cell Transplantation May Backfire-- Rick Ansorge
Wednesday, July 29, 2009
WEDNESDAY, July 29 (HealthDay News) -- In patients with hematologic cancers who undergo transplantation of hematopoietic stem cells from partially matched family donors, leukemic cells can escape immunological pressure from the alloreactive donor T cells and cause a relapse, according to a study published in the July 30 issue of the New England Journal of Medicine.
Luca Vago, M.D., of the Hospital San Raffaele-Telethon Institute for Gene Therapy in Milan, Italy, and colleagues studied 43 patients -- 36 with acute myeloid leukemia and seven with high-risk myelodysplastic syndrome -- who underwent haploidentical transplantation and infusion of donor T cells.
In five of the 17 patients who relapsed, the researchers identified genomic loss of the patient-specific HLA haplotype. They suggest that the loss most likely resulted from selective pressure mediated by alloreactive donor T cells.
"The report by Vago et al. is a salutary reminder that leukemic cells can escape even the most powerful antigen-driven T-cell suppression," state the authors of an accompanying editorial. "The investigators' observations indicate that the control of leukemia by a stem-cell transplant from an HLA-disparate donor is more limited than had been thought and suggest that other methods of tumor control may improve the outcome."
One co-author reported receiving consulting fees from MolMed.
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