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Surico PL, Luo ZK. Understanding Ocular Graft-Versus-Host Disease to Facilitate an Integrated Multidisciplinary Approach. Transplant Cell Ther 2024:S2666-6367(24)00493-7. [PMID: 38986740 DOI: 10.1016/j.jtct.2024.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/10/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
Ocular Graft-versus-Host Disease (oGVHD) remains a challenging and potentially devastating complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT). It significantly impacts the quality of life of affected survivors, however, is often underrecognized particularly during the early stages. Targeting all providers in the HSCT community who see patients regularly and frequently for their post-allo-HSCT care, this review and opinion piece introduces the basic concepts of ocular surface pathophysiology, dissects the different stages of clinical presentation of oGVHD, explains why the current diagnostic criteria tend to capture the late disease stages, highlights the warning signs of early disease development, in hope to facilitate prompt referral of oGVHD suspects for ocular specialist care. In addition to introducing a comprehensive list of treatment options, this review emphasizes basic therapeutic strategy and options that are safe and effective to be initiated by any care provider. We believe in empowering the patients as well as the care providers beyond disciplinary boundaries, in order to provide the most cohesive and integrated care to our patients in a multidisciplinary approach.
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Affiliation(s)
- Pier Luigi Surico
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Campus Bio-Medico University, Department of Ophthalmology, Rome, Italy
| | - Zhonghui K Luo
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
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Rees MJ, Rivalland A, Tan S, Xie M, Yong MK, Ritchie D. Non-viral pathogens of infectious diarrhoea post-allogeneic stem cell transplantation are associated with graft-versus-host disease. Ann Hematol 2024; 103:593-602. [PMID: 37926752 DOI: 10.1007/s00277-023-05526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
Infectious diarrhoea is common post-allogeneic haematopoietic stem-cell transplantation (alloHSCT). While the epidemiology of Clostridioides difficile infection (CDI) post-alloHSCT has been described, the impact of other diarrhoeal pathogens is uncertain. We reviewed all alloHSCT between 2017 and 2022 at a single large transplant centre; 374 patients were identified and included. The 1-year incidence of infectious diarrhoea was 23%, divided into viral (13/374, 3%), CDI (65/374, 17%) and other bacterial infections (16/374, 4%). There was a significant association between infectious diarrhoea within 1 year post-transplant and the occurrence of severe acute lower gastrointestinal graft-versus-host disease (GVHD, OR = 4.64, 95% CI 2.57-8.38, p < 0.001) and inferior GVHD-free, relapse-free survival on analysis adjusted for age, donor type, stem cell source and T-cell depletion (aHR = 1.64, 95% CI = 1.18-2.27, p = 0.003). When the classes of infectious diarrhoea were compared to no infection, bacterial (OR = 6.38, 95% CI 1.90-21.40, p = 0.003), CDI (OR = 3.80, 95% CI 1.91-7.53, p < 0.001) and multiple infections (OR = 11.16, 95% CI 2.84-43.92, p < 0.001) were all independently associated with a higher risk of severe GI GVHD. Conversely, viral infections were not (OR = 2.98, 95% CI 0.57-15.43, p = 0.20). Non-viral infectious diarrhoea is significantly associated with the development of GVHD. Research to examine whether the prevention of infectious diarrhoea via infection control measures or modulation of the microbiome reduces the incidence of GVHD is needed.
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Affiliation(s)
- Matthew J Rees
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia.
| | - Alexandra Rivalland
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Sarah Tan
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Mingdi Xie
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Michelle K Yong
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Victorian Infectious Diseases Service, Melbourne Health, Melbourne, Australia
- Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Melbourne, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 305 Grattan St, Melbourne, VIC, 3000, Australia
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Blennerhassett R, Othman J, Biscoe A, Kliman D, Mills G, Blyth E, Micklethwaite K, Kwan J, Bilmon I, Bhattacharyya A, Panicker S, Fay K, Milliken S, Ma D, Hamad N, Stevenson W, Arthur C, Moore J, Greenwood M, Gottlieb D, Kerridge I. Long-term outcomes of corticosteroid graft versus host disease prophylaxis in peripheral blood allogeneic haemopoietic stem cell transplant: a comparative cohort analysis. Intern Med J 2023; 53:1979-1986. [PMID: 36878730 DOI: 10.1111/imj.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/12/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Corticosteroids (CSs) have previously been incorporated into graft versus host disease (GVHD) prophylaxis regimens for bone marrow (BM) and haemopoietic stem cell transplant (HSCT). AIMS To assess the impact of prophylactic CS in HSCT using peripheral blood (PB) stem cells. METHODS Patients were identified from three HSCT centres receiving a first PB-HSCT between January 2011 and December 2015 from a fully human leukocyte antigen (HLA)-matched sibling or unrelated donor for acute myeloid leukaemia or acute lymphoblastic leukaemia. To enable meaningful comparison, patients were divided into two cohorts. RESULTS Cohort 1 included only myeloablative-matched sibling HSCT, where the only variation in GVHD prophylaxis was the addition of CS. In these 48 patients, there were no differences in GVHD, relapse, non-relapse mortality, overall survival or GVHD-relapse-free-survival (GRFS) at 4 years after transplant. Cohort 2 included the remaining HSCT recipients, where one group received CS-prophylaxis and the non-CS group received an antimetabolite, ciclosporin and anti-T-lymphocyte globulin. In these 147 patients, those receiving CS-prophylaxis experienced higher rates of chronic GVHD (71% vs 18.1%, P < 0.001) and lower rates of relapse (14.9% vs 33.9%, P = 0.02). Those receiving CS-prophylaxis had a lower 4-year GRFS (15.7% vs 40.3%, P = 0.002). CONCLUSIONS There does not appear to be a role for adding CS to standard GVHD prophylaxis regimens in PB-HSCT.
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Affiliation(s)
- Richard Blennerhassett
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
| | - Jad Othman
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Amber Biscoe
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - David Kliman
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Georgia Mills
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
| | - Emily Blyth
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kenneth Micklethwaite
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - John Kwan
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ian Bilmon
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Abir Bhattacharyya
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Shyam Panicker
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Keith Fay
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sam Milliken
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
| | - David Ma
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame Australia, School of Medicine, Sydney, New South Wales, Australia
| | - William Stevenson
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Chris Arthur
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - John Moore
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
| | - Matthew Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Gottlieb
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Puckrin R, Kwan ACF, Blosser N, Leyshon C, Duggan P, Daly A, Zepeda V, Stewart D, Chaudhry A, Storek J, Jamani K. Corticosteroids as graft-versus-host disease prophylaxis for allogeneic hematopoietic cell transplant recipients with calcineurin inhibitor intolerance. Cytotherapy 2023; 25:1101-1106. [PMID: 37306643 DOI: 10.1016/j.jcyt.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/01/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AIMS Although calcineurin inhibitors (CNIs) have a well-established role in the prevention of graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT), their use can be limited by significant toxicities, which may result in premature treatment discontinuation. The optimal management of patients with CNI intolerance is unknown. The objective of this study was to determine the effectiveness of corticosteroids as GVHD prophylaxis for patients with CNI intolerance. METHODS This retrospective single-center study included consecutive adult patients with hematologic malignancies who underwent myeloablative peripheral blood allogeneic HCT with anti-thymocyte globulin, CNI, and methotrexate GVHD prophylaxis in Alberta, Canada. Multivariable competing-risks regression was used to compare cumulative incidences of GVHD, relapse, and non-relapse mortality between recipients of corticosteroid versus continuous CNI prophylaxis, and multivariable Cox proportional hazards regression was applied to compare overall survival, relapse-free survival (RFS) and moderate-to-severe chronic GVHD and RFS. RESULTS Among 509 allogeneic HCT recipients, 58 (11%) patients developed CNI intolerance and were switched to corticosteroid prophylaxis at median 28 days (range 1-53) after HCT. Compared with patients who received continuous CNI prophylaxis, recipients of corticosteroid prophylaxis had significantly greater cumulative incidences of grade 2-4 acute GVHD (subhazard ratio [SHR] 1.74, 95% confidence interval [CI] 1.08-2.80, P = 0.024), grade 3-4 acute GVHD (SHR 3.22, 95% CI 1.55-6.72, P = 0.002), and GVHD-related non-relapse mortality (SHR 3.07, 95% CI 1.54-6.12, P = 0.001). There were no significant differences in moderate-to-severe chronic GVHD (SHR 0.84, 95% CI 0.43-1.63, P = 0.60) or relapse (SHR 0.92, 95% CI 0.53-1.62, P = 0.78), but corticosteroid prophylaxis was associated with significantly inferior overall survival (hazard ratio [HR] 1.77, 95% CI 1.20-2.61, P = 0.004), RFS (HR 1.54, 95% CI 1.06-2.25, P = 0.024), and chronic GVHD and RFS (HR 1.46, 95% CI 1.04-2.05, P = 0.029). CONCLUSIONS Allogeneic HCT recipients with CNI intolerance are at increased risks of acute GVHD and poor outcomes despite institution of corticosteroid prophylaxis following premature CNI discontinuation. Alternative GVHD prophylaxis strategies are needed for this high-risk population.
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Affiliation(s)
- Robert Puckrin
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada.
| | - Alex Chi Fung Kwan
- Cross Cancer Institute and University of Alberta, Edmonton, Alberta, Canada
| | - Nikki Blosser
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada
| | - Catherine Leyshon
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada
| | - Peter Duggan
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada
| | - Andrew Daly
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada
| | - Victor Zepeda
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada
| | - Douglas Stewart
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada
| | - Ahsan Chaudhry
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada
| | - Jan Storek
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada
| | - Kareem Jamani
- Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada
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McClelland J, Wong E, Grigg A. Optimizing the oral dose of cyclosporine with concomitant posaconazole post stem cell allograft. Leuk Lymphoma 2023; 64:440-444. [PMID: 36368718 DOI: 10.1080/10428194.2022.2142054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cyclosporine is an immunosuppressive agent to prevent acute graft versus host disease (GVHD) in patients undergoing a stem cell allograft. It has a narrow therapeutic range, and its metabolism can be affected by posaconazole, commonly used as antifungal prophylaxis post allograft. There is limited evidence on the optimal oral cyclosporine starting dose in this setting. A delicate balance is required in dose adjustments to avoid toxic levels while maintaining sufficient drug concentrations to prevent GVHD. We undertook a retrospective audit of 28 patients undergoing their first allograft who received posaconazole and commenced on a starting oral cyclosporine dose of 2 mg/kg twice daily. Our key findings were that this starting dose was too high, with all patients experiencing at least one toxicity and an overall low incidence of GVHD.
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Affiliation(s)
- Julia McClelland
- Department of Clinical Haematology, Austin Health, Melbourne, Australia
| | - Eric Wong
- Department of Clinical Haematology, Austin Health, Melbourne, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Melbourne, Australia
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Ramzi M, Haghighat S, Namdari N, Haghighinejad H. Combination of Low-Dose, Short-Course Mycophenolate Mofetil With Cyclosporine and Methotrexate for Graft-Versus-Host Disease Prophylaxis in Allogeneic Stem Cell Transplant. EXP CLIN TRANSPLANT 2020; 19:1328-1333. [PMID: 32778017 DOI: 10.6002/ect.2020.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES With the standard regimen for graft-versushost disease prophylaxis in allogeneic stem cell transplant with human leukocyte antigen-matched donor, grade II-IV acute graft-versus-host disease occurs in 30% to 50% of sibling and up to 80% of unrelated recipients. Studies with limited patient numbers have shown efficacy and safety of mycophenolate mofetil for graft-versus-host disease prophylaxis. We investigated the effect of low-dose mycophenolate mofetil added to a standardized prophylaxis regimen for graft-versus-host disease in related human leukocyte antigen-matched allogeneic stem cell transplant. MATERIALS AND METHODS In this prospective randomized clinical trial, we compared cyclosporine and methotrexate versus the combination of cyclosporine, methotrexate, and mycophenolate mofetil in all patients who underwent human leukocyte antigencompatible related donor allogeneic stem cell transplant for acute leukemia during 3 years at the Bone Marrow Transplant Unit at Namazi Hospital, Shiraz University of Medical Sciences (Shiraz, Iran). RESULTS All 134 patients in both groups underwent successful engraftment. Recovery times for neutrophils and platelets were not significantly different between groups (P < .05). Incidence of acute graft-versus-host disease in the cyclosporine, methotrexate, and mycophenolate mofetil group was less than in the cyclosporine and methotrexate group (21.6% vs 40.9%; P = .041). Incidence of grade II-IV acute graftversus-host disease in the mycophenolate mofetil group was 15.2% versus the control group at 33% (P = .045). CONCLUSIONS Our single-center study suggests the combination of mycophenolate mofetil, cyclosporine, and methotrexate is superior to the standard regimen of cyclosporine and methotrexate for graft-versushost disease prophylaxis after human leukocyte antigen-matched related donor allogeneic stem cell transplant.
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Affiliation(s)
- Mani Ramzi
- From the Hematology Research Center and Bone Marrow Transplantation Center, Shiraz University of Medical Sciences, Shiraz, Iran
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7
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Comparative efficacy of 20 graft-versus-host disease prophylaxis therapies for patients after hematopoietic stem-cell transplantation: A multiple-treatments network meta-analysis. Crit Rev Oncol Hematol 2020; 150:102944. [DOI: 10.1016/j.critrevonc.2020.102944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/08/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
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Abstract
Graft‐versus‐host disease (GvHD) is an important complication that can be observed after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Acute GvHD (aGvHD) is seen after allo-HSCT and the incidence of aGvHD is around 30%-50%. aGvHD prophylaxis is essential in patients undergoing allo-HSCT. Initial therapy for aGvHD is steroids. Prognosis is poor in aGvHD patients not responding to steroids. In this article, the pathobiology, clinical findings, prophylaxis, and treatment of aGvHD will be summarized.
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Affiliation(s)
- Elifcan Aladağ
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Engin Kelkitli
- Ondokuz Mayıs University Faculty of Medicine, Department of Hematology, Samsun, Turkey
| | - Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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Ruutu T, Nihtinen A, Niittyvuopio R, Juvonen E, Volin L. A randomized study of cyclosporine and methotrexate with or without methylprednisolone for the prevention of graft-versus-host disease: Improved long-term survival with triple prophylaxis. Cancer 2017; 124:727-733. [DOI: 10.1002/cncr.31100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Tapani Ruutu
- Stem Cell Transplantation Unit, Comprehensive Cancer Center; Helsinki University Hospital; Helsinki Finland
| | - Anne Nihtinen
- Stem Cell Transplantation Unit, Comprehensive Cancer Center; Helsinki University Hospital; Helsinki Finland
| | - Riitta Niittyvuopio
- Stem Cell Transplantation Unit, Comprehensive Cancer Center; Helsinki University Hospital; Helsinki Finland
| | - Eeva Juvonen
- Stem Cell Transplantation Unit, Comprehensive Cancer Center; Helsinki University Hospital; Helsinki Finland
| | - Liisa Volin
- Stem Cell Transplantation Unit, Comprehensive Cancer Center; Helsinki University Hospital; Helsinki Finland
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11
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Superior outcome using cyclosporin A alone versus cyclosporin A plus methotrexate for post-transplant immunosuppression in children with acute leukemia undergoing sibling hematopoietic stem cell transplantation. J Cancer Res Clin Oncol 2014; 141:1089-94. [DOI: 10.1007/s00432-014-1885-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 11/23/2014] [Indexed: 12/14/2022]
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12
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O'Connor CM, Wilson-Robles H. Developing T Cell Cancer Immunotherapy in the Dog with Lymphoma. ILAR J 2014; 55:169-81. [DOI: 10.1093/ilar/ilu020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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13
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Higher CD3+ and CD34+ cell doses in the graft increase the incidence of acute GVHD in children receiving BMT for thalassemia. Bone Marrow Transplant 2011; 47:107-14. [DOI: 10.1038/bmt.2011.3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hoyt R, Ritchie DS, Wirth A, Szer J, Grigg AP. Etoposide induces more severe mucositis than CY when added to TBI as conditioning in allograft recipients receiving CsA and MTX. Bone Marrow Transplant 2010; 45:1457-62. [DOI: 10.1038/bmt.2009.365] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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15
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Li JM, Giver CR, Lu Y, Hossain MS, Akhtari M, Waller EK. Separating graft-versus-leukemia from graft-versus-host disease in allogeneic hematopoietic stem cell transplantation. Immunotherapy 2009; 1:599-621. [PMID: 20191089 PMCID: PMC2827928 DOI: 10.2217/imt.09.32] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Routine methods to maximize the graft-versus-leukemia (GvL) activity of allogeneic hematopoietic stem cell transplantation (HSCT) without the detrimental effects of graft-versus-host disease (GvHD) are lacking. Depletion or inhibition of alloreactive T cells is partially effective in preventing GvHD, but usually leads to decreased GvL activity. The current model for the pathophysiology of acute GvHD describes a series of immune pathways that lead to activation of donor T cells and inflammatory cytokines responsible for tissue damage in acute GvHD. This model does not account for how allotransplant can lead to GvL effects without GvHD, or how the initial activation of donor immune cells may lead to counter-regulatory effects that limit GvHD. In this review, we will summarize new findings that support a more complex model for the initiation of GvHD and GvL activities in allogeneic HSCT, and discuss the potential of novel strategies to enhance GvL activity of the transplant.
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Affiliation(s)
| | | | | | | | | | - Edmund K Waller
- Author for correspondence: Department of Hematology/Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road NE, Room C4002, Atlanta, GA 3032, USA Tel.: +1 404 727 4995 Fax: +1 404 778 5530
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