Immune cell transplant extends pancreatic cancer survival to two decades
A small clinical trial found that three pancreatic cancer patients survived 19-21 years after surgery combined with allogeneic stem cell transplantation, compared to one to four years for untreated controls. The findings suggest immunotherapy could transform outcomes for a disease that typically kills patients within months, potentially reshaping oncology treatment protocols and clinical trial design.
Originaltitel: Long term survival in three pancreatic cancer patients following Whipple’s procedure and allogeneic hematopoietic cell transplantation
Allogena stamcellstransplantationer kan öka långtidsöverlevnaden hos utvalda pancreascancerpatienter. Forskargruppen vid Karolinska Institutet följde tre patienter med avancerad pankreasductal adenokarcinom (PDAC) som genomgick Whipples operation följd av allogén hematopoetisk celltransplantation (HCT). En patient överlevde 21 år utan recidiv trots påföljande munhålscancer; en annan 19 år innan död av esofaguscancer; den tredje 15 år, cancerfri trots graftöverkastring. Samtliga tre kontrollpatienter utan HCT dog inom ett till fyra år. Patienterna uppvisade graft-versus-host-effekter (GVHD), vilket kan reflektera en antitumörmekananism. Resultaten antyder att HCT möjliggör långsiktig överlevnad vid helt resecerad PDAC, en diagnos med normalt dödlig prognos. Befintligheter kräver validering i större kohorter före klinisk implementering, men öppnar vägen för personaliserad immunoterapeutisk strategi vid resektabel sjukdom.
Introduction Pancreatic ductal adenocarcinoma (PDAC) is associated with an extremely poor prognosis, with long-term survival being exceedingly rare. Here, we follow-up on three long-term survivors. Methods This study initially included eight patients with PDAC who underwent radical resection via Whipple’s procedure with no evidence of distant metastases. Two of these patients received allogeneic hematopoietic cell transplantation (HCT) in a previously published trial. The remaining six patients, who served as controls and did not receive HCT, died of progressive PDAC within one to four years. Additionally, a 60-year-old male with PDAC who underwent partial pancreatectomy and gastrectomy received HCT from a matched unrelated donor. Results Patient 1 developed mild acute graft-versus-host disease (GVHD) of the skin, followed by chronic GVHD. He subsequently underwent surgery for oral cancer and remains alive 21 years after the initial PDAC diagnosis, with no evidence of recurrence. Patient 2 experienced severe acute gastrointestinal GVHD and recurrent chronic bronchiolitis obliterans. He died of esophageal cancer 19 years after PDAC diagnosis. Patient 3 experienced graft rejection and multiple medical complications, including radical surgery for colorectal cancer, yet remains cancer-free 15 years after PDAC diagnosis. Discussion In conclusion, HCT may confer anticancer effects in patients with radically resected PDAC. Further investigations are warranted to confirm its therapeutic value. ClinicalTrials.gov Identifier: NCT02207985