Prevention of graft rejection following bone marrow transplantation

Gale, Robert Peter; Ho, Winston G.; Feig, Stephen A.; Champlin, Richard E.; Tesler, Alan; Arenson, Edward B.; Ladish, Stephan; Young, Lowell S.; Winston, Drew J.; Sparkes, Robert S.; Fitchen, John H.; Territo, Mary; Sarna, G; Wong, Livingston; Paik, Young Suk; Bryson, Yvonne J.; Golde, David W.; Fahey, John L.; Cline, Martin J.

doi:10.1182/blood.v57.1.9.bloodjournal5719

Cited by 31 publications

(4 citation statements)

References 21 publications

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“…Intravenous mesna 100 mg/kg/day was used as uroprotection. The total body irradiation dose was 300 cGy on day 1 for matched stem cell transplants [13] or 200 cGy twice a day on day 2~1 for mismatched or unrelated transplants [40]. Patients received granulocyte-colony stimulating factor 5 ug/kg subcutaneously beginning on day 1.…”

Section: Protocolmentioning

confidence: 99%

Hematopoietic stem cell transplantation for severe aplastic anemia—experience of an institute in Taiwan

et al. 2003

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Hematopoietic stem cell transplantation (HSCT) is an accepted treatment strategy for patients with severe aplastic anemia (SAA). We report our experience in a general hospital in Taiwan. From March 1985 to July 2001, 79 consecutive SAA patients, 46 male and 33 female, with a median age of 22 (4-43) years, received 80 courses of transplantation. Cyclophosphamide and total body radiation were used for the conditioning regimen, and cyclosporine-A and methotrexate for graft-versus-host disease (GVHD) prevention. Patients were followed for a median of 39 months (from 8 days to 194 months). Myeloid and platelet engraftment occurred in a median of 15 (8-27) days and 18 (8-77) days, respectively. Three patients had primary and three patients secondary graft failure. Five patients (6.8%) had grade II-IV acute GVHD in 73 evaluable patients. Chronic GVHD occurred in 23 (34.8%) patients, with extensive stage in six. Only two patients had CMV disease. The projected 3- and 5-year overall survival rates estimated by the Kaplan-Meier method were 76.08 and 74.13%, respectively. Age at transplant, non-sibling donor, mononuclear cell dose, grade II-IV acute GVHD, interval from diagnosis to transplant, and red blood cell and platelet transfusion before transplant were poor prognostic factors for overall survival by univariate analysis. Grade II-IV acute GVHD was the only prognostic factor affecting overall survival after multivariate Cox regression analysis (P=0.040). In conclusion, SAA patients receiving HSCT have good long-term survival. The low incidence of acute GVHD in our patients may be related to ethnicity.

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Section: Protocolmentioning

confidence: 99%

Hematopoietic stem cell transplantation for severe aplastic anemia—experience of an institute in Taiwan

et al. 2003

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“…Rejection was thought to result from the sensitization of patients to the minor histocompatibility antigens of donors induced by the previous blood product transfusion (22, 23). To reduce the risk of graft rejection, more intensive conditioning regimens which combine CY with other agents such as ATG, procarbazine or with radiation (24–28) and newly devised methods such as the addition of the donor's peripheral blood buffy‐coat cells to the marrow (29, 30) were developed. In 1983, Feig et al (27) showed encouraging results in this setting with a new conditioning regimen consisting of CY and TBI of 3 Gy.…”

Section: Discussionmentioning

confidence: 99%

Bone marrow transplantation in children with severe aplastic anemia using a conditioning regimen containing 3 Gy of total body irradiation, cyclophosphamide with or without antithymocyte globulin

Inagaki

Nagatoshi

Kawano

et al. 2006

Pediatric Transplantation

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We have employed the 3 Gy total body irradiation (TBI) containing conditioning regimen to bone marrow transplantation (BMT) for severe aplastic anemia (SAA) in pediatric patients irrespective of donor type since March 1986. The outcome of BMT for 17 SAA patients is favorable. Eight patients received BMT from human leukocyte antigen matched-related donors (MRD) and nine received BMT from alternative donors. The conditioning regimen consisted of 3-Gy TBI and cyclophosphamide of 200 mg/kg in the BMT from MRD. In the case of BMT from alternative donor, antithymocyte globulin 10 mg/kg was added to the regimen. Fifteen of 17 patients (88%) engrafted on median of day 18 (range, 11-26) and all 13 evaluable patients showed complete donor chimerism by median 30 (range, 13-47) days after BMT. Fourteen patients have survived with a median follow-up of 67 (range, 2-228) months and the probability of survival was 81.9% (95% CI, 63.3-100%). No late complications including second malignancies caused by TBI have been observed and all three female patients have regular menstruation. In conclusion, TBI of 3 Gy appears to be an appropriate dose regarding to ensure engraftment and avoid the risk of late adverse event for SAA patients.

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“…In the initial experiences of MSD-SCT using CY alone conditioning, high incidence of graft failure was a major challenge, particularly in previous heavily transfused patients [ 55 ]. Subsequently, MSD-SCT using radiation, including local-field and total-body irradiation (TBI), plus CY conditioning was attempted and resulted in a lower incidence of graft failure, but was associated with relatively higher incidences of long-term regimen-related morbidities and mortality [ 56 , 57 , 58 , 59 ]. Thereafter, several investigators attempted MSD-SCT using CY plus ATG conditioning, which might induce both effective immunoablation and lymphoablation [ 60 , 61 , 62 , 63 ].…”

Section: Allogeneic Sct For Patients With Saamentioning

confidence: 99%

Recent advances in treatment of aplastic anemia

Shin

Lee

2014

Korean J Intern Med

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Recent advances in the treatment of aplastic anemia (AA) made most of patients to expect to achieve a long-term survival. Allogeneic stem cell transplantation (SCT) from HLA-matched sibling donor (MSD-SCT) is a preferred first-line treatment option for younger patients with severe or very severe AA, whereas immunosuppressive treatment (IST) is an alternative option for others. Horse anti-thymocyte globuline (ATG) with cyclosporin A (CsA) had been a standard IST regimen with acceptable response rate. Recently, horse ATG had been not available and replaced with rabbit ATG in most countries. Subsequently, recent comparative studies showed that the outcomes of patients who received rabbit ATG/CsA were similar or inferior compared to those who received horse ATG/CsA. Therefore, further studies to improve the outcomes of IST, including additional eltrombopag, are necessary. On the other hand, the upper age limit of patients who are able to receive MSD-SCT as first-line treatment is a current issue because of favorable outcomes of MSD-SCT of older patients using fludarabine-based conditioning. In addition, further studies to improve the outcomes of patients who receive allogeneic SCT from alternative donors are needed. In this review, current issues and the newly emerging trends that may improve their outcomes in near futures will be discussed focusing the management of patients with AA.

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Prevention of graft rejection following bone marrow transplantation

Cited by 31 publications

References 21 publications

Hematopoietic stem cell transplantation for severe aplastic anemia—experience of an institute in Taiwan

Hematopoietic stem cell transplantation for severe aplastic anemia—experience of an institute in Taiwan

Bone marrow transplantation in children with severe aplastic anemia using a conditioning regimen containing 3 Gy of total body irradiation, cyclophosphamide with or without antithymocyte globulin

Recent advances in treatment of aplastic anemia

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