A new induction protocol for the control of steroid refractory/dependent acute graft versus host disease with alefacept and tacrolimus

Shapira, Michael Y.; Resnick, Igor B.; Dray, Liliane; Aker, Memet; Stepensky, Polina; Sharon, Elad; Gesundeheidt, B.; Samuel, Simcha; Or, Reuven

doi:10.1080/14653240802644669

Cited by 15 publications

(6 citation statements)

References 13 publications

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“…The benefits of thymoglobulin used for steroid refractory GVHD disease [21] involved only mild cases [15,22], and the experience has not been uniformly good [23,24]. Other therapies used have proven either ineffective or too toxic, although some encouraging results have been reported, as with sirolimus [25] or alefacept [26]. Infliximab, an antibody against α-TNF, can be beneficial in patients with steroid-refractory acute GVHD [27] particularly when the intestine, specially the lower gastrointestinal tract, is involved in the GVHD [27,28].…”

Section: Discussionmentioning

confidence: 95%

Graft-vs-host disease after small bowel transplantation in children

Andrés

Santamarı́a

Ramos

et al. 2010

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 95%

Graft-vs-host disease after small bowel transplantation in children

Andrés

Santamarı́a

Ramos

et al. 2010

Journal of Pediatric Surgery

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“…Alefacept also showed potential benefit for treatment of GVHD in bone marrow transplantation recipients. 52 Unfortunately, Alefacept, has been discontinued by the manufacturers, without any safety or FDA regulation concerns. 53 Sipilizumab is a similar agent that targets the CD2 receptor on T-lymphocytes and natural killer cells.…”

Section: Discussionmentioning

confidence: 99%

Graft Versus Host Disease After Liver Transplantation in Adults

Murali¹,

Chandra

Stewart

et al. 2016

Transplantation

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Background Graft-versus-host-disease (GVHD) after liver transplantation (LT) is a deadly complication with very limited data on risk factors, diagnosis and management. We report a case series and a comprehensive review of the literature. Methods Data was systematically extracted from reports of GVHD after LT, and from the United Network for Organ Sharing (UNOS) database. Group comparisons were performed. Results 156 adult patients with GVHD after LT have been reported. Median time to GVHD onset was 28 days. Clinical features were skin rash (92%), pancytopenia (78%) and diarrhea (65%). 6-month mortality with GVHD after LT was 73%. Sepsis was the most common cause of death (60%). Enterobacter bacteremia, invasive aspergillosis and disseminated Candida infections were frequently reported. Recipient age over 50-years is a risk factor for GVHD after LT. Hepatocellular carcinoma (HCC) was over-represented, while chronic hepatitis C was under-represented, in reported United States GVHD cases relative to all UNOS database LT cases. Mortality rate with treatment of GVHD after LT was 84% with high-dose steroids alone, 75–100% with regimens using dose increases of calcineurin inhibitors (CNI), and 55% with IL-2 antagonists. Mortality was 25% in small case series using the CD2-blocker alefacept or tumor necrosis factor-α (TNF-α) antagonists. Conclusions Age over 50-years and HCC appear to be risk factors for GVHD. Hepatitis C may be protective. High-dose steroids and CNI are ineffective in the treatment of GVHD after LT. CD2-blockers and TNF-α antagonists appear promising. We propose a diagnostic algorithm to assist clinicians in managing adults with GVHD after LT.

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“…HLA mismatch causes the donor-derived immune cells to respond to the host's tissue where the host is perceived as foreign [42]. Donor-mediated attack of host tissue could involve multiple systems, such as the gastrointestinal tract, skin and liver [43]. These events are thought to be partly a result of minor histocompatibility antigen mismatch [44].…”

Section: Clinical Correlationsmentioning

confidence: 99%

Stem Cell Transplantation for Hematological Malignancies: Prospects for Personalized Medicine and Co-therapy with Mesenchymal Stem Cells

Patel¹,

Rameshwar²

2011

CPPM

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Bone marrow transplantation is a form of cell therapy that has been in practice for decades for the treatment of hematological disorders and solid tumors. Immunosuppressive therapy has been a mainstay for treatment, but the severity of the adverse effects has made it an undesirable choice. Mesenchymal stem cells (MSCs), which reside in the vascular regions of the bone marrow, have been shown to serve as cellular support for the hematopoietic stem cell (HSC) niche. Furthermore, the immune suppressive properties of MSCs have been explored in the treatment of inflammatory and autoimmune disorders. Thus, co-therapy with MSCs has been shown to facilitate engraftment of hematopoietic cells by suppressive graft versus host disease (GvHD). Although the mechanism by which MSCs suppress GvHD is unclear, the experimental evidence suggests that this partly occurs by modulation of immune response such as the induction of regulatory T cells. This paper discusses the role of MSCs as co-therapy for the future of stem cell transplantation, with the overarching theme of personalized medicine for cell-based health interventions.

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A new induction protocol for the control of steroid refractory/dependent acute graft versus host disease with alefacept and tacrolimus

Cited by 15 publications

References 13 publications

Graft-vs-host disease after small bowel transplantation in children

Graft-vs-host disease after small bowel transplantation in children

Graft Versus Host Disease After Liver Transplantation in Adults

Stem Cell Transplantation for Hematological Malignancies: Prospects for Personalized Medicine and Co-therapy with Mesenchymal Stem Cells

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