Immune-Boosted Autologous Hematopoietic Cell Transplantation (IBAHCT)

Autologous BMT/HCT is also known as high dose chemotherapy with stem cell rescue. What that means is to be able to give a higher dose of chemotherapy with the idea and the intent that chemotherapy would eliminate the residual cancer. However, with such high doses, the bone marrow is the first to take a hit and is unable to rejuvenate on its own. To sustain life, then the patient requires a "Stem Cell Rescue" to repopulate the marrow. Hence, hematopoietic stem cells have to be collected before the chemotherapy is administered and frozen to preserve, and reinfused following the chemotherapy.

While this process is effective in curing a proportion of patients in Lymphoma and prolonging survival in patients with Myeloma, an allogenic transplantation from a compatible donor under similar circumstances has been found to cure 2–3 times more patients. This is primarily because the donor immune cells effectively eradicate the last cancer cell (GvL) in the patient's body. In a same way, these cells attack the normal cells and tissues in the patient's body (GvHD). This phenomenon is rarely been described in an Autologous BMT. Hence, the GvL effect is not appreciably noted in this process.

However, we noticed a similar phenomenon akin to GvHD as seen following Allogenic BMT in certain patients of Lymphoma undergoing Autologous BMT. We explored the treatment process that these patients underwent prior to the BMT, and discovered a common agent that they had received. Studying the various mechanisms of action of this agent, we realised there were certain pathways by which this agent was boosting the immune system of the patient and possibly leading to the GvHD-like phenomenon that we noted.

Following this observation, we designed a protocol where low doses of this agent were employed before the collection of the stem cells and after Autologous BMT at certain fixed time points, in advanced patients with Lymphoma and Myeloma. The initial results are extremely promising.