Stem cell-based treatments for gynecological solid tumors.

BACKGROUND AND OBJECTIVE We have recently assisted to an increasing scientific interest and a new research effort in the field of stem cell-based therapy. Since the late 1980s hematopoietic stem cells (HSC) have been used to set up therapeutic strategies for the treatment of solid tumors such as gynecological cancers. In this context, different approaches have been suggested and clinically investigated. STATE OF THE ART In the autologous setting we can describe the well-known use of HSC as hematologic support to high-dose chemotherapy regimens, and the use of HSC as a source of dendritic cells for cancer vaccination protocols. In our institution a long-term experience has been developed in high-dose chemotherapy with autologous HSC transplantation as first-line treatment of advanced ovarian cancer, and in the use of cytokines both for HSC collection and for post-transplantation hematopoietic recovery and immune reconstitution. An alternative approach consists of allogenic HSC transplantation following either myeloablative/standard or non-myeloablative/reduced conditioning regimens, which have been proposed as new adoptive immunotherapeutic treatments for different non-hematologic malignancies. PERSPECTIVES Future strategies in the use of HSC in oncology comprise the possibility of HSC ex-vivo expansion, the use of umbilical cord blood HSC, and the development of HSC-based gene-therapy programs. Further investigations are expected in the new field of cancer stem cells.