No abstract

No abstract

Summary. Clinical evidence of a graft-vs.-tumour effect in solid tumours after haematopoietic stem cell transplantation is lacking. We report for the first time a complete and durable regression of a stage IB non-small-cell lung carcinoma in a patient who had received an allogeneic peripheral blood haematopoietic stem cell transplant for acute myeloblastic leukaemia in first complete remission. Disappearance of the tumour coincided with development of graft-vs.-host disease. This suggests that simultaneous generation of cytotoxic T lymphocytes against lung carcinoma cells could have been responsible for the regression. This unique clinical observation broadens the possibility of using allogeneic haematopoietic stem cell transplantation in treating neoplasias lacking significant sensitivity to chemotherapy.Keywords: graft-vs.-tumour-effect, lung cancer, allogeneic stem cell transplantation.The graft-vs.-tumour effect (GVT) after allogeneic bone marrow transplantation (BMT) is closely related to the development of graft-vs.-host disease (GVHD). It contributes to the elimination of residual disease and the achievement of durable remissions in several haematological malignancies, particularly chronic myeloid leukaemia (Weiden et al, 1979;Butturini et al, 1987;Horowitz et al, 1990;Verdonk et al, 1996;van Besien et al, 1997;Collins et al, 1997). However, information about the possible clinical role of GVT in solid tumours is lacking.We describe here a patient with acute myeloblastic leukaemia (AML) allografted with peripheral blood stem cells (PBSCs) from his HLA-identical sister, in whom a limited squamous cell lung cancer was detected early after transplant. The lung cancer lesion disappeared. This coincided with the development of acute and chronic GVHD, without specific treatment. This suggests that a GVT effect could eliminate tumour cells in such cases. CASE REPORTA 52-year-old man, a heavy smoker (40 cigarettes/d for the past 35 years), with AML M5a in first complete remission (CR), received a non-manipulated allogeneic PBSC transplant from his HLA-identical sister. The conditioning regimen consisted of busulphan and cyclophosphamide, and cyclosporin and prednisone were given for GVHD prophylaxis. Engraftment was fast, and he developed a grade III acute GVHD that responded to prednisone. The patient was admitted to hospital on d 74 because of cytomegalovirus antigenaemia, fever, left basal lobar pneumonia and flares of GVHD on his skin. A bronchoscopy revealed an unexpected infiltrative and ulcerated lesion in the division between the left lobar superior and inferior bronchi (Fig 1A). Cytology suggested squamous cell carcinoma of the lung, and a transbronchial lung biopsy confirmed this diagnosis (Fig 2). The clinical staging of the tumour was IB (Mountain, 1997). Given his clinical condition, surgery and chemotherapy were ruled out. The patient was managed with intravenous antibiotics, gancyclovir and high-dose methylprednisolone, with resolution of the pneumonia and partial response of the GVHD. A bronchoscop...

No abstract