![]() ![]() 11, 12 Thereafter, the numbers of such cells increase to a plateau at 6 to 9 months. 10 The relative and absolute numbers of circulating cells expressing CD19 and CD20, two markers of mature B cells, are decreased during the first 3 months following transplantation. 9 In both its Ig gene rearrangements and in phenotypic expression, B-cell recovery after transplantation appears to recapitulate normal B-cell ontogeny. Normal B-cell differentiation is accompanied by a set of preprogrammed steps of Ig gene rearrangement and by successive acquisition and loss of differentiation level-specific surface molecules. In addition, the potential to accelerate immune reconstitution and the effect that might have in the therapy of malignant disease will be considered. In this review, several strategies that could lead to enhancement of cellular immune function to take particular advantage of posttransplantation minimal residual disease will be discussed. It may have direct clinical implications: Immediately after the administration of intensive cytotoxic drugs, minimal tumor burden is presumed to be present, providing potentially ideal circumstances to eliminate residual disease altogether by immunotherapeutic means. This restoration of immune function is not merely experimental. These include (1) reappearance of functional B cells, (2) thymic and extra-thymic T-cell development, (3) reconstitution of effector cells including cytotoxic T cells and natural killer (NK) cells, and (4) efficient antigen presentation to reconstitute the pretransplantation immune repertoire. ![]() All rights reserved.Immune reconstitution involves several components of the immune response. This review provides estimates for response and survival to aid in decision making when considering ASCT for patients with PCNSL.Ĭonditioning chemotherapy Consolidation Induction chemotherapy.Ĭopyright © 2018 Elsevier Inc. The thiotepa, busulfan, and cyclophosphamide regimen, on the other hand, showed numerically superior OS and PFS rates. Subgroup analysis showed that the use of carmustine and thiotepa as a conditioning regimen carried the lowest risk of transplant-related mortality. In the salvage/relapse settings, 85% of patients experienced or maintained complete response or partial response after ASCT. The overall risk of relapse at 5 years was 24%. The rates of overall survival (OS) and progression-free survival (PFS) were 94%, 86%, 82%, and 70% and 79%, 70%, 64%, and 54% after 1, 2, 3, and 5 years, respectively. In the consolidation setting, 94% of patients experienced or maintained complete or partial response after ASCT. Thiotepa, busulfan, and cyclophosphamide and carmustine/thiotepa were commonly used conditioning regimens. ASCT was used as consolidative treatment or as salvage treatment/at relapse. We screened 1517 references and included 43 studies. Studies that reported survival outcomes after ASCT were included. Two investigators independently assessed study eligibility and extracted the data. Autologous stem-cell transplantation (ASCT) is increasingly used as an alternative consolidative treatment to whole-brain radiotherapy.Ī systematic search of several databases was conducted up through January 10, 2018. Primary central nervous system lymphoma (PCNSL) is an aggressive form of non-Hodgkin lymphoma.
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