Allogeneic Bone Marrow Transplantation For Metastatic Renal Cell Carcinoma: The European Experience

Main Category: Urology / Nephrology
Also Included In: Transplants / Organ Donations
Article Date: 04 Sep 2006 - 0:00 PDT

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UroToday.com - Allogeneic bone marrow transplantation is yet another treatment option for patients with metastatic renal cell carcinoma (mRCC), where initial reports by Childs out of the National Cancer Institute demonstrated significant disease responses. However, significant treatment related morbidity and mortality, as well as the development of other targeted therapies, have tempered enthusiasm for this treatment option. In this report by Barkholt and colleagues, the experience with this treatment modality in Europe is described.

In this 21 center experience, the outcomes of 124 patients who underwent allogeneic bone marrow transplantation (BMT) are described, with a median follow-up of 15 months. All patients but 6 had prior cytoreductive nephrectomy. Immunosuppression for BMT was achieved with either cyclosporine alone or in combination with methotrexate or mycophenolate mofetil. Donor lymphocyte infusions were given to 42 patients. Moderate to severe acute graft versus host disease (GVHD) was noted in 40% and 30% developed chronic GVHD. Treatment related mortality was 16% at one year. The authors noted 4 complete responses, 24 partial responses, 24 with stable disease, with the remainder of patients demonstrating disease progression. Factors associated with significant improvement in survival and response included the following:

Development of chronic GVHD - HR 4.12 - p<0.001
Donor lymphocyte infusion - HR 3.39 - p<0.001
< 3 metastatic sites - HR 2.61 - p=0.002
Karnofsky PS >70 - HR 2.33 - p=0.03

Patients who developed chronic GVHD and had a donor lymphocyte infusion had a 70% 2-year survival. Tumor response correlated with < 1 year from diagnosis of mRCC to BMT, HLA mismatched donor, and development of acute GVHD, grade II-IV. The overall 2-year survival for the entire series was 30%.

By Christopher G. Wood, M.D.

Ann Oncol., 2006 Jul;17(7):1134-40. Epub 2006 Apr 28.
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