Allogeneic Stem Cell Transplantation

DLI for T cell leukemia and lymphoma – pro

Donor lymphocyte infusions are designed to awaken some degree of graft versus host reaction, which contains within it also the graft versus disease effect. It is a modality that can be used after allogeneic transplantation to treat relapse by "awakening" an immune response. . Almost all work on DLI was in B cell leukemias and lymphomas.  How it affects T cell malignancies is not well studied and most of what is known was in Adult T-Cell leukami/Lymphoma.

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Velcade for Graft Versus Host DIsease – pro

Koreth found that Velcade was beneficial in GVHD; but his was a phase II trial and other phase II trials are ongoing. He found that i the 45 patients who were treated in the study; 89% of patients were treated with a one-locus and 11% of patients were treated with a two-loci mismatch. With a median follow-up of 3 years, the 180-day cumulative incidence of grade 2 to 4 acute GVHD was 22%, and the 1-year cumulative incidence of chronic GVHD was 29%.

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Rituxan for PTLD -pro

Post-transplant lymphoproliferative disease (PTLD) remains a major complication after solid organ and allogeneic stem cell transplantation. It is usually related to outgrowth of lymphocytes infected with Epstein-Barr virus (EBV). Following titers and an individualized treatment plan including decreased immunosuppression and other agents should be chosen based on the severity and extent of disease. Some classify  PTLD into three groups(1):  Early

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Graft versus host disease (GVHD) prophylaxis – pro

Calcineurin inhibitors, such as cyclosporine and tacrolimus,  are commonly used in the prophylaxis of GvHD (BCH guideline). For full-intensity stem cell transplantation most centres use a combination of a calcineurin inhibitor, such as ciclosporin or tacrolimus, given in combination with methotrexate. Low-dose methotrexate was the first generally prescribed GVHD preventive regimen for use as a cell-cycle specific chemotherapeutic agent following

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Busulfan, fludarabine and thymogen (ATG) as conditioning for allogeneic stem cell transplantation – pro

The regimen of busulafan. fludarabine and thymogen has been very quickly adopted and now studies of it as a base for adding additonal drugs have been initiated. However, there is room for caution. Thymoglobulin added to busulfan and fludarabine to conditioning before an allogeneic stem cell transplant may reduce the incidence and severity of graft versus host disease, especially in matched unrelated graft, but it can potentially promote higher reapse

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Prophylactic Acyclovir after stem cell transplantation – pro

Both allogeneic and autologous hematopoietic cell transplant (HCT) recipients are at increased risk for a variety of infections based upon their degree of immunosuppression and exposures, more so the allogeneic transplant recipients. The types of infections to which these hosts are most vulnerable can be roughly divided based upon their temporal relation to the transplantation: Preengraftment — less than three weeks mmediate postengraftment —

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Prostate Px – pro

Risk assessment can be useful to clinicians because it allows assessment of risk versus benefit of partcular treatments. Risk assessment methods currently used for newly diagnosed prostate cancer patients have disadvantages. THey include: D’Amico risk categories, Partin probability tables, University of California, San Francisco-Cancer of the Prostate Risk Assessment risk score, and Kattan nomograms; all rely heavily on traditional clinical variables

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Transformed follicular lymphoma – pro

Lay Summary: Transplants for transformed follicular lymphoma are supported by follicular lymphoma (transformed) guidelines of the NCCN. There is trial evidence supporting this approach. Takvorian and colleagues (1987) studied 49 patients with either high-grade (n = 29), intermediate-grade (n =14) or low-grade (n = 6) lymphoma. All patients were considered to have a poor prognosis either due to relapse (n = 41) or poor prognostic factors (n = 8).

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Novel induction regimens in transplantation for mantle cell lymphoma – pro

Lay Summary: Stem cell transplantation is standard of care for mantle cell lymphoma. Mantle cell lymphoma is a fairly recently identified subtype of non-Hodgkin's lymphoma. Regarded as a low-grade tumour in previous classifications, it has a median survival of only 36 months and is incurable by current treatment approaches. Widespread disease is usually present at diagnosis involving lymph nodes, spleen, bone marrow and extranodal sites such as the

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Autologous and allogeneic stem cell transplantation for diffuse large cell lymphoma (NHL) – pro

Summary: NHL is currently the second most frequent indication for autologous hematopoietic stem cell transplantation. It is not a useful treatment option for all patients with NHL, but in certain circumstances, autologous stem cell transplantation does provide patients the best opportunity for cure. Diffuse large-cell lymphoma is the most common form of NHL, and autologous stem cell transplantation has been shown to be beneficial in some subsets

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