Encouraging preliminary results in 12 patients with high-risk haematological malignancies by omitting graft-versus-host disease prophylaxis after allogeneic transplantation.

Abstract

Immunosuppressive therapy, routinely given after allogeneic transplantation to modulate graft-versus-host disease (GVHD) may have an adverse effect on the graft-versus-tumour (GVT) effect. Twelve patients with high-risk haematological malignancies were given cyclophosphamide, total body irradiation and antithymocyte globulin followed by peripheral blood stem cell grafts from HLA-identical siblings without prophylactic immunosuppression. At the earliest clinical evidence of GVHD, patients were treated with high-dose solumedrol and tacrolimus. Prompt haematological recovery [absolute neutrophil count (ANC) > 1.0 x 109/l] was observed (median time 9 d). All patients developed grade III-IV GVHD (median onset 9 d), involving the skin (11), intestine (five) and liver (three). Of nine evaluable patients, seven developed chronic GVHD [extensive (six), limited (one)]. Six patients died 1-6.5 months after transplantation. Three patients died from treatment-related complications, two from acute GVHD and one from relapsing disease. The remaining six patients are alive 5-26 months after transplantation, five in complete remission and one myeloma patient in very good partial remission. In conclusion, omission of post-transplantation GVHD prophylaxis is feasible, does not lead to graft failure or a high incidence of uncontrollable GVHD and appears to be associated with encouraging clinical responses in a group of patients with high-risk disease features.

• Authors: A B Fassas, A P Rapoport, M Cottler-Fox, T Chen, G Tricot
• Journal: British journal of haematology (Br J Haematol) Vol. 111 Issue 2 Pg. 662-7 (Nov 2000) ISSN: 0007-1048 [Print] England
• PMID: 11122119 (Publication Type: Journal Article)

Chemical References

• Glucocorticoids
• Prednisone

Topics

• Acute Disease
• Adult
• Bone Marrow Transplantation
• Female
• Follow-Up Studies
• Glucocorticoids (therapeutic use)
• Graft vs Host Disease (drug therapy)
• Graft vs Tumor Effect
• Humans
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (immunology, surgery)
• Leukemia, Myeloid (immunology, surgery)
• Leukemia-Lymphoma, Adult T-Cell (immunology, surgery)
• Lymphoma, B-Cell (immunology, surgery)
• Lymphoma, Mantle-Cell (immunology, surgery)
• Male
• Middle Aged
• Multiple Myeloma (immunology, surgery)
• Pilot Projects
• Prednisone (therapeutic use)
• Transplantation, Homologous