Graft versus Host Disease

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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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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Conditioning for allogeneic transplantation in Aplastic Anemia – pro

In younger patients with Aplastic Anemia)AA), the standard conditioning proposed by the Working Party on SAA (WPSAA) is cyclophosphamide 50 mg/kg 32 × 4 + ATG. This regimen is nonmyeloablative and highly immunosuppressive to prevent graft rejection and GVHD. Often ATG(Thymogen) is also added. The benefit of adding ATG to cyclophosphamide is unclear, because a recently published prospective randomized clinical trial (RCT) from CIBMTR showed no significant

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