Document Detail


Prophylaxis for acute graft-versus-host disease following unrelated donor bone marrow transplantation.
MedLine Citation:
PMID:  7539667     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Despite the use of conventional chemoprophylaxis regimens, patients receiving unrelated-donor BMT are at high risk of developing severe acute GVHD. We evaluated a prophylactic regimen combining CsA, MTX and anti-CD5-ricin A chain immunotoxin (H65-RTA) in 31 patients; pentoxifylline was also given to reduce the anticipated nephrotoxicity of CsA. In most cases, planned doses of CsA, MTX and H65-RTA were given (i.e. to 77%, 77% and 93% of patients, respectively). Although fluid retention requiring diuretic therapy was frequent, only 1 patient had a > 10% unexplained increase in body weight during the first 21 days post-BMT. Also, while significant increase of the baseline serum creatinine was noted in 7 patients, none required dialysis. One patient suffered a reversible allergic reaction to the immunotoxin; no other side effects attributable to this regimen were observed. All but 2 patients engrafted (1 died of fungemia on d + 19 and the other had persistent leukemia) and no late graft failures were observed. Seventeen patients developed acute GVHD grade > or = II (probability, 58% [95% CI 41-76%]); 7 had grade > or = III (probability, 24% [95% CI 12-43%]). In the 27 patients who achieved stable engraftment and have survived beyond d + 100, the 3-year probability of developing chronic GVHD was 66% (95% CI 48-84%). As of the last follow-up prior to 01 May 1994, 13 patients are alive in CR and one in relapse; 9 of these patients are off all immunosuppressives and well. Four other patients relapsed and died, and 13 died of other transplant-related causes.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
G L Phillips; T J Nevill; J J Spinelli; S H Nantel; H G Klingemann; M J Barnett; J D Shepherd; K W Chan; J M Meharchand; H J Sutherland
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Bone marrow transplantation     Volume:  15     ISSN:  0268-3369     ISO Abbreviation:  Bone Marrow Transplant.     Publication Date:  1995 Feb 
Date Detail:
Created Date:  1995-07-07     Completed Date:  1995-07-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8702459     Medline TA:  Bone Marrow Transplant     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  213-9     Citation Subset:  IM    
Affiliation:
Leukemia/Bone Marrow Transplantation Program of British Columbia, Vancouver Hospital and Health Sciences Centre, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antigens, CD / immunology
Antigens, CD5
Bone Marrow Transplantation / adverse effects*
Child
Child, Preschool
Cyclosporine / administration & dosage*
Drug Administration Schedule
Female
Follow-Up Studies
Graft Survival
Graft vs Host Disease / prevention & control*
Histocompatibility Testing
Humans
Immunotoxins / administration & dosage*
Infant
Male
Methylprednisolone / administration & dosage*
Middle Aged
Chemical
Reg. No./Substance:
0/Antigens, CD; 0/Antigens, CD5; 0/Immunotoxins; 59865-13-3/Cyclosporine; 83-43-2/Methylprednisolone

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