Ash Shifra, Askenasy Nadir
Pediatric Hematology Oncology and Bone Marrow Transplantation Division, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel; Frankel Laboratory of Bone Marrow Transplantation, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Frankel Laboratory of Bone Marrow Transplantation, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Crit Rev Oncol Hematol. 2023 May;185:103956. doi: 10.1016/j.critrevonc.2023.103956. Epub 2023 Mar 7.
Neuroblastoma represents a relatively common childhood tumor that imposes therapeutic difficulties. High risk neuroblastoma patients have poor prognosis, display limited response to radiochemotherapy and may be treated by hematopoietic cell transplantation. Allogeneic and haploidentical transplants have the distinct advantage of reinstitution of immune surveillance, reinforced by antigenic barriers. The key factors favorable to ignition of potent anti-tumor reactions are transition to adaptive immunity, recovery from lymphopenia and removal of inhibitory signals that inactivate immune cells at the local and systemic levels. Post-transplant immunomodulation may further foster anti-tumor reactivity, with positive but transient impact of infusions of lymphocytes and natural killer cells both from the donor, the recipient or third party. The most promising approaches include introduction of antigen-presenting cells in early post-transplant stages and neutralization of inhibitory signals. Further studies will likely shed light on the nature and actions of suppressor factors within tumor stroma and at the systemic level.
神经母细胞瘤是一种相对常见的儿童肿瘤，治疗困难。高危神经母细胞瘤患者预后较差，对放化疗反应有限，可能需要接受造血细胞移植治疗。同种异体移植和单倍体移植具有恢复免疫监视的明显优势，并受到抗原屏障的强化。有利于引发强效抗肿瘤反应的关键因素包括向适应性免疫的转变、淋巴细胞减少的恢复以及去除在局部和全身水平使免疫细胞失活的抑制信号。移植后的免疫调节可能会进一步促进抗肿瘤反应，来自供体、受体或第三方的淋巴细胞和自然杀伤细胞输注具有积极但短暂的影响。最有前景的方法包括在移植后早期引入抗原呈递细胞以及中和抑制信号。进一步的研究可能会阐明肿瘤基质内和全身水平抑制因子的性质和作用。
