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New England Journal of Medicine 08/2011; 365(6):571-2; author reply 573-4. · 53.30 Impact Factor
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ABSTRACT: Reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (HSCT) can result in reliable donor engraftment, relatively low treatment-related mortality, and sustained remissions in the treatment of multiple myeloma. However, substantial cytoreduction pre-allografting is often necessary because of a variable graft-versus-myeloma effect. The use of RIC allogeneic HSCT immediately after autologous HSCT provides a temporal separation between tumor reduction by high-dose chemotherapy and the graft-versus-myeloma effect. There are currently a number of prospective trials attempting to address the issue of whether this strategy leads to decreases in relapse and/or improvement in overall survival as compared with double autologous transplants. Unfortunately, similar to autografting, relapse remains the major cause of treatment failure after RIC allogeneic HSCT. To improve treatment results with allografting, consideration should be given to incorporating immunomodulatory drugs and targeted treatments to enhance pretransplantation remission status, as posttransplantation maintenance therapy, or in combination with donor lymphocyte infusions for refractory or relapsed disease. Studies exploring these strategies are ongoing.
Clinical lymphoma, myeloma & leukemia 06/2011; 11(3):247-52.
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Oncology (Williston Park, N.Y.) 04/2011; 25(4):378, 380. · 1.03 Impact Factor
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ABSTRACT: Although the majority of patients with Hodgkin lymphoma achieve sustained remission with frontline treatment, there is still a subset of patients with much less favorable prognosis. The current standard of care for Hodgkin lymphoma patients with relapsed or refractory disease is autologous stem cell transplantation. However, no randomized trial has compared autologous stem cell transplantation with allogeneic stem cell transplantation prospectively, and most studies comparing allogeneic stem cell transplantation with historical controls of autologous stem cell transplantation use a myeloablative conditioning reference group. With the more frequent use of reduced-intensity conditioning transplantation in recent studies, the role for allogeneic stem cell transplantation in Hodgkin lymphoma patients is being redefined. In contrast to other types of lymphomas, Hodgkin lymphoma patients are younger at diagnosis, which makes a curative strategy such as allogeneic stem cell transplantation particularly appealing. This review examines the role of allogeneic stem cell transplantation in Hodgkin lymphoma by looking at both retrospective and prospective analyses in the era of reduced-intensity conditioning transplantation, donor lymphocyte infusions, and biologically based treatments.
Current Hematologic Malignancy Reports 10/2010; 5(4):229-38.
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ABSTRACT: Idiopathic CD4(+) T lymphocytopenia (ICL) is defined as a CD4(+) T-cell count <0.3 x 10(9)/l or <20% of the total T-cell count on two occasions in the absence of any immunodeficiency disorder or therapy associated with reduced CD4(+) T-cell count. Although several mechanisms of ICL have been reported, the pathophysiology is still largely unknown. This case report describes a patient who presented with cryptococcal meningitis and was subsequently discovered to meet the criteria for ICL. Flow cytometric analysis of the patient's peripheral blood mononuclear cells revealed antibodies coating a much larger proportion of his CD4(+) T cells (33.61%) than the CD4(+) T cells of normal donors (3.94 +/- 1.77%). The reasons behind the development of these autoantibodies are explored.
British Journal of Haematology 11/2007; 139(1):133-7. · 4.94 Impact Factor
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ABSTRACT: Peptides are the smallest antigenic components that are recognized by T cells when presented in MHC molecules on the cell surface. After the identification of peptides from tumor associated and tumor specific antigens, the exploration of the use of peptides in immunotherapy of cancer was instigated. From initial exploration of peptide-mediated induction of immune responses in mice, the peptide based vaccines have evolved to clinical testing in cancer patients. Many different clinical trials have been performed to address the ability of peptide-based vaccines to induce both clinical and immunological responses in patients. This review will provide an overview of the results of the majority of the clinical trials with peptide-based vaccines directed against various antigens in patients with solid tumors.
Frontiers in Bioscience 06/2002; 7:e204-13. · 3.52 Impact Factor
