Autologus bone marrow transplantation and posttransplant immunotherapy

Abstract

High dose chemotherapy followed by stem cell rescue is the treatment of choice for a variety of solid tumors and hematologic malignancies. The autologous bone marrow transplantation is associated with low mortality rate in comparison to allogeneic transplantation. However, the relapse rate is higher than allogeneic and similar to singeneic transplantation and clinical results depend on the nature and stage of primary disease. Disease free survival is higher when autologous patients are transplantated in remission or with minimal residual disease and it is reduced when transplantation is performed in advanced stages. Cellular adoptive immunotherapy refers to the use of allogeneic lymphocytes as antitumor agents. On the other hand, the rationale for using Interleukin-2 in autologous bone marrow transplantation setting is the absence of immunological barrier between donor and recipient and the possible elimination of residual cells that were infused with marrow cells. As relapse occurs in the first months posttransplant, immunotherapy must be used early in the context of minimal residual disease.