Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study.

Myeloablative allo-SCT decreases relapse incidence (RI) in ALL. Reduced intensity conditioning (RIC) may extend allo-SCT to older and less fit patients. Sixty-nine ALL patients reported to the BSBMT underwent fludarabine-based RIC allo-SCT, 38 from unrelated donors (UD). Forty-four patients received alemtuzumab. ALL was in CR in 64 patients (93%). This was a second or third SCT in 23 patients. Two-year OS and PFS were 36% and 32%, respectively. In multivariate analysis male recipients demonstrated better OS and PFS (hazard ratio (HR) = 0.42, P = 0.008 and HR = 0.45, P = 0.012, respectively). Two-year TRM was 29%: higher with younger age (HR = 0.97/year, P = 0.041), female recipient (HR = 2.55, P = 0.049) and increasing grade of acute GVHD (HR = 1.87, P = 0.001). Two-year RI was 38% and was lower in patients with acute and chronic GVHD (HR = 0.62 per increasing grade, P = 0.035 and HR = 0.52, P = 0.025, respectively). Long-term ALL-free survival is achievable following fludarabine-based RIC allo-SCT. The association between GVHD and decreased RI suggests the presence of a GVL effect.

Protein degradation in MHC class II antigen presentation: opportunities for immunomodulation.

Proteolysis is required for two steps of the MHC class II antigen-processing pathway, degradation of invariant chain and cleavage of protein antigens. Invariant chain dissociation from MHC is limited by a final proteolytic event which is tightly regulated in both temporal and tissue-specific ways. In contrast, enzymes involved in antigen proteolysis remain ill-defined. Gene 'knockout' experiments of housekeeping proteolytic enzymes suggest either that these enzymes do not play a major role, or that antigen proteolysis is too degenerate for this type of analysis. The possible role of two other proteinases, cathepsin E and aspariginyl endopeptidase is discussed. Finally, the data implicating antigen processing in repertoire generation is briefly considered. We conclude that selective regulation of endosomal proteolysis could have profound implications for control of immunity against infection, as well as in autoimmunity.

IFN-gamma down-regulates MHC expression and antigen processing in a human B cell line.

IFN-gamma is a crucial mediator in the induction of cell-mediated Th1-type responses but is predominantly a negative regulator of B cell differentiation and proliferation. This cytokine is therefore a key factor in determining Th1 vs Th2 differentiation. This study investigates the action of IFN-gamma in modulation of HLA-DR expression and Ag presentation by EBV-transformed human B cell lines. In contrast to its action on the monocyte/macrophage, IFN-gamma down-regulates surface MHC expression on these B cells, and this regulation is posttranscriptional. In parallel with MHC down-regulation, there is a reduced capability to process and present exogenous protein and peptide Ag to T cell hybridomas. IFN-gamma does not change the rates of fluid phase endocytosis or exocytosis in this model system but correlates with an up-regulation of the lysosomal enzymes cathepsins B and D.