Source:http://linkedlifedata.com/resource/pubmed/id/10100557
Switch to
| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions | |
| pubmed:issue |
5
|
| pubmed:dateCreated |
1999-6-22
|
| pubmed:abstractText |
From March 1994 to September 1997, 30 patients with hematological malignancies (12 ANLL, 10 CML, four ALL and four multiple myeloma) received HLA-identical allogeneic bone marrow transplants with the marrow graft selectively depleted of CD4+ lymphocytes and the CD8+ cell content adjusted to 1x10(6)/kg. Total depletion of CD4+ and partial depletion of CD8+ lymphocytes was carried out by an immunomagnetical method. All patients were considered as having high risk for developing GVHD by at least one of the following criteria: patient age >35 years; donor age >35 years; donor multiparity or marrow from an unrelated donor. Twenty-four cases received marrow from an identical sibling and six from an unrelated donor. In order to assess the role of methotrexate (MTX) in addition to cyclosporin A (CsA) after transplant, patients were randomly assigned to received either CsA alone (n = 15) or CsA plus a short course of MTX (n = 15). No case of primary graft failure was observed, but two patients developed late graft failure. Six patients presented grade II acute GVHD and no case of severe III-IV GVHD was seen. The actuarial probability of developing grade II-IV acute GVHD was 25.9+/-9.6% for the entire population. Patients receiving post-transplant CsA + MTX had significantly less probability of acute GVHD than those receiving CsA exclusively (6.7+/-6.4% vs. 50.5+/-17.8%, P = 0.03) and the schedule of post-transplant immunosuppression was the only factor associated with the incidence of acute GVHD in a multivariate analysis. The actuarial incidence of chronic GVHD for the entire population was 31.8+/-12.5, and there was no significant difference between both groups with additional prophylaxis. Four patients with CML and three with ANLL relapsed: the actuarial probability of remaining in complete remission for all patients was 53.6+/-17.3%. For patients with acute leukemia, the probability of remaining in complete remission did not differ significantly between those transplanted in first complete remission and those receiving a transplant in more advanced phases of the disease (87.5+/-11.6% vs. 72.9+/-16.5%; P = 0.44). The incidence of mixed chimerism assessed by PCR was 34%. Nineteen patients are alive between 2 and 43 months post-transplant, the probability of overall survival being 57.8+/-10.4%. Our data indicate that this method of selective T cell depletion is very effective in preventing acute GVHD in high risk patients, particularly when used in combination with post-transplant CsA + MTX.
|
| pubmed:language |
eng
|
| pubmed:journal | |
| pubmed:citationSubset |
IM
|
| pubmed:chemical | |
| pubmed:status |
MEDLINE
|
| pubmed:month |
Mar
|
| pubmed:issn |
0268-3369
|
| pubmed:author | |
| pubmed:issnType |
Print
|
| pubmed:volume |
23
|
| pubmed:owner |
NLM
|
| pubmed:authorsComplete |
Y
|
| pubmed:pagination |
443-50
|
| pubmed:dateRevised |
2006-4-24
|
| pubmed:meshHeading |
pubmed-meshheading:10100557-Adolescent,
pubmed-meshheading:10100557-Adult,
pubmed-meshheading:10100557-Antineoplastic Combined Chemotherapy Protocols,
pubmed-meshheading:10100557-Bone Marrow Transplantation,
pubmed-meshheading:10100557-CD4-Positive T-Lymphocytes,
pubmed-meshheading:10100557-CD8-Positive T-Lymphocytes,
pubmed-meshheading:10100557-Child,
pubmed-meshheading:10100557-Combined Modality Therapy,
pubmed-meshheading:10100557-Female,
pubmed-meshheading:10100557-Graft vs Host Disease,
pubmed-meshheading:10100557-Hematologic Neoplasms,
pubmed-meshheading:10100557-Histocompatibility Testing,
pubmed-meshheading:10100557-Humans,
pubmed-meshheading:10100557-Immunomagnetic Separation,
pubmed-meshheading:10100557-Immunosuppressive Agents,
pubmed-meshheading:10100557-Lymphocyte Depletion,
pubmed-meshheading:10100557-Male,
pubmed-meshheading:10100557-Methotrexate,
pubmed-meshheading:10100557-Middle Aged,
pubmed-meshheading:10100557-Transplantation, Homologous,
pubmed-meshheading:10100557-Treatment Outcome
|
| pubmed:year |
1999
|
| pubmed:articleTitle |
Prevention of graft-versus-host disease in high risk patients by depletion of CD4+ and reduction of CD8+ lymphocytes in the marrow graft.
|
| pubmed:affiliation |
Department of Hematology, Hospital Reina Sofia, Córdoba, Spain.
|
| pubmed:publicationType |
Journal Article,
Clinical Trial,
Randomized Controlled Trial
|