Autologous/syngeneic stem cell transplantation to treat refractory GvHD

Passweg, Jakob; Orchard, Kim; Buergi, A.; Gratwohl, Aloïs; Powles, R; Goldman, John M.; Apperley, Jane F.; Mehta, Jayesh

doi:10.1038/sj.bmt.1704658

Cited by 8 publications

(3 citation statements)

References 14 publications

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“…We see several directions for future research toward improving survival of patients with severe gut GVHD: 1) clinical trials of novel therapies to blunt both cellular and innate immune reactions after the onset of GVHD symptoms; 2) clinical trials to modulate epithelial and endothelial tight junctions affected by the inflammatory milieu and stimulation of epithelial regeneration to restore mucosal integrity; 3) consideration of reconditioning and transplanting either an autologous or allogeneic hematopoietic cell graft for patients who otherwise would have a very poor survival. 36–39 Very little progress has been made in improving therapy for severe gut GVHD during the past 30 years. The results of this study should be considered in designing future studies of severe gut acute GVHD and in counseling patients about prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation

Castilla-Llorente

Martin

McDonald

et al. 2014

Bone Marrow Transplant

134

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We hypothesized that clinical risk factors could be identified within 2 weeks of onset of severe (stage 3 or 4) acute gut GVHD for identifying a patient population with a very poor outcome. Among 1,462 patients who had allogeneic hematopoietic cell transplantation (HCT) between January 2000 and December 2005, 116 (7.9%) developed stage 3–4 gut GVHD. The median time to onset of stage 3–4 gut GVHD was 35 (4–135) days after allogeneic HCT. Eighty-five of the 116 patients (73%) had corticosteroid-resistance before or within 2 weeks after the onset of stage 34 gut GVHD. Significant risk factors for mortality included corticosteroid-resistance (HR=2.93; p=0.0005), age >18 years (HR=4.95; p=0.0004), increased serum bilirubin (HR 2.53; p=0.0001), and overt gastrointestinal bleeding (HR 2.88; p=0.0004). Among patients with stage 3–4 gut GVHD, the subgroup with 0, 1 or 2 risk factors had a favourable prognosis, whereas the subgroup with 3 or 4 risk factors had a dismal prognosis. This information should be considered in designing future studies of severe gut GVHD and in counseling patients about prognosis.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation

Castilla-Llorente

Martin

McDonald

et al. 2014

Bone Marrow Transplant

134

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“…However, all but one patient died due to GVHD (three patients), relapse (two patients), infection (one patient) or multiorgan failure (one patient). 10 The aim of this survey was to obtain an overview on the practice of the European Group for Blood and Marrow Transplantation (EBMT) centers in the collection and application of autologous HSC back-ups.…”

Section: Introductionmentioning

confidence: 99%

The harvest and use of autologous back-up grafts for graft failure or severe GVHD after allogeneic hematopoietic stem cell transplantation: a survey of the European Group for Blood and Marrow Transplantation

Stelljes

Biezen

Slavin

et al. 2008

Bone Marrow Transplant

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Autologous hematopoietic stem cells (HSCs) harvested as back-up prior to allogeneic hematopoietic SCT (HSCT) may potentially be useful in the treatment of graft failure or in cases with severe GVHD. Here, we studied the general policies and indications for autologous back-up harvest among the European Group for Blood and Marrow Transplantation centers in the year 2003. The outcome of patients receiving autologous back-up transfusion between 1998 and 2002 was evaluated retrospectively. The responses from 94 centers showed that 48 centers had a general policy with variable indications for autologous back-up harvest. Thirty-five patients with graft failure (25), GVHD (8) or relapse (2) retransplanted with autologous back-ups were reported. Autologous back-up transfusion was performed at a median of 35 days (patients with graft failure) or 90 days (patients with GVHD) after allogeneic HSCT. Within 100 days after autologous HSCT, 21 patients died from treatmentrelated complications (19) or relapse (2). Estimated overall survival at 1 year was 16% (95% CI 0-32%) for patients treated for graft failure and 13% (95% CI 0-37%) for GVHD patients. In conclusion, our data demonstrate that the indication for autologous back-up harvests is limited and that general storage and use cannot be recommended unless in selected prospective studies.

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“…A similar case was previously reported by Ricordi 5 who reported reversal of steroid-refractory cutaneous GVHD following combined liver-bone marrow allo-transplant by infusion of stored recipient autologous bone marrow. Passweg et al 6 have recently reported eight patients (seven aGVHD and one cGVHD) after allogeneic HSCT, who failed a median of four lines of therapy and were then treated with a 'rescue' transplant using autologous cells or syngeneic donor cells with the aim of improving the severe refractory GVHD. In four of five patients who received some form of conditioning before autologous cell infusion, mixed chimerism or complete recipient hematopoiesis was restored with a resolution of GVHD in four patients.…”

mentioning

confidence: 99%

Reversal of severe graft-versus-host disease after nonmyeloablative matched unrelated donor stem cell transplant by infusion of backup autologous peripheral blood stem cells

Khan

Moreb

2005

Bone Marrow Transplant

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Autologous/syngeneic stem cell transplantation to treat refractory GvHD

Cited by 8 publications

References 14 publications

Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation

Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation

The harvest and use of autologous back-up grafts for graft failure or severe GVHD after allogeneic hematopoietic stem cell transplantation: a survey of the European Group for Blood and Marrow Transplantation

Reversal of severe graft-versus-host disease after nonmyeloablative matched unrelated donor stem cell transplant by infusion of backup autologous peripheral blood stem cells

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