Therapeutic Apheresis Immunologic Graft Engineering for the Treatment of Cancer

The role of therapeutic apheresis in the treatment of cancer has been mainly palliative by relieving symptoms produced by the underlying malignancy. Reports linking therapeutic apheresis with superior clinical outcomes in cancer patients were lacking until the discovery of graft-versus-tumor effect produced by the infusion of allo-reactive donor lymphocyte obtained during stem cell collection in allogeneic stem cell transplantation. Furthermore, the better clinical outcomes observed after relapse from allogeneic stem cell transplantation by infusing the patient with donor lymphocyte infusion suggested that therapeutic apheresis can be viewed as an adoptive immunotherapeutic strategy. However, the infused allo-reactive donor lymphocytes producing the graft-versus-tumor effect are also associated with the high morbility and mortality complication of graft-versus-host disease. Recent reports have shown that we can develop an autologous-graft-versus-tumor effect without the complication of graft-versus-host disease by manipulating the apheresis machine during stem cell collection for autologous stem cell transplantation. In this review, we address the rationale to use the apheresis machine to engineer immunocompetent autograft to improve survival in cancer patients.