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Autologous/syngeneic stem cell transplantation to treat refractory GvHD

Autologous/syngeneic stem cell transplantation to treat refractory GvHD
Autologous/syngeneic stem cell transplantation to treat refractory GvHD

Severe graft-versus-host disease (GvHD) refractory to corticosteroids responds poorly to experimental treatment and is often fatal. Attempts have been made to 'rescue' such patients by transfusing autologous cells in order to ablate the lymphoid component of the graft or to introduce regulatory cells capable of suppressing the GvHD. Here, we report details of eight patients with severe grade III-IV acute GvHD (n=7) or extensive chronic GvHD (n=1) who after failing a median of four lines of treatment were then treated with either autologous or syngeneic nucleated cell transfusions. Patients received standard conditioning (n=3), low intensity (n=2) or no conditioning (n=3) before the rescue procedure. In four of the five patients who received some form of conditioning, mixed chimerism or complete recipient hematopoiesis was restored. The GvHD resolved in four patients, of whom one died subsequently of multiorgan failure and two died of leukemia; one is still alive. A fifth patient had transient improvement in GvHD, which recurred when the corticosteroids were reduced. Three patients obtained no benefit from the procedure. We conclude that 'rescue' by transfusion of autologous or syngeneic nucleated cells may be valuable to treat severe refractory GvHD; the best approach to conditioning remains to be defined.

Adult, Female, Graft vs Host Disease, Humans, Leukemia, Myeloid, Male, Middle Aged, Peripheral Blood Stem Cell Transplantation, Salvage Therapy, Transplantation Chimera, Transplantation Conditioning, Transplantation, Autologous, Transplantation, Isogeneic, Journal Article
0268-3369
995-8
Passweg, J R
70c511ab-b2c3-4400-ab8f-cbf3ae6e08db
Orchard, K
794654ab-d6cc-488a-ac11-c9217433c7a2
Buergi, A
73362bff-cc70-4494-bc1e-640cdef472e6
Gratwohl, A
e66f069e-4c2e-4ffc-b251-3e2dfae11e5b
Powles, R
eb6545e2-2f37-48d3-9fb1-1a0a74f97c33
Goldman, J
773443db-4283-495f-b2db-60d8227fa393
Apperley, J
622c945c-74c1-4773-a80f-2bdafe8dfe14
Mehta, J
357f6026-6d4a-46fd-a44f-8cb0b8b5a7f7
Passweg, J R
70c511ab-b2c3-4400-ab8f-cbf3ae6e08db
Orchard, K
794654ab-d6cc-488a-ac11-c9217433c7a2
Buergi, A
73362bff-cc70-4494-bc1e-640cdef472e6
Gratwohl, A
e66f069e-4c2e-4ffc-b251-3e2dfae11e5b
Powles, R
eb6545e2-2f37-48d3-9fb1-1a0a74f97c33
Goldman, J
773443db-4283-495f-b2db-60d8227fa393
Apperley, J
622c945c-74c1-4773-a80f-2bdafe8dfe14
Mehta, J
357f6026-6d4a-46fd-a44f-8cb0b8b5a7f7

Passweg, J R, Orchard, K, Buergi, A, Gratwohl, A, Powles, R, Goldman, J, Apperley, J and Mehta, J (2004) Autologous/syngeneic stem cell transplantation to treat refractory GvHD. Bone Marrow Transplantation, 34 (11), 995-8. (doi:10.1038/sj.bmt.1704658).

Record type: Article

Abstract

Severe graft-versus-host disease (GvHD) refractory to corticosteroids responds poorly to experimental treatment and is often fatal. Attempts have been made to 'rescue' such patients by transfusing autologous cells in order to ablate the lymphoid component of the graft or to introduce regulatory cells capable of suppressing the GvHD. Here, we report details of eight patients with severe grade III-IV acute GvHD (n=7) or extensive chronic GvHD (n=1) who after failing a median of four lines of treatment were then treated with either autologous or syngeneic nucleated cell transfusions. Patients received standard conditioning (n=3), low intensity (n=2) or no conditioning (n=3) before the rescue procedure. In four of the five patients who received some form of conditioning, mixed chimerism or complete recipient hematopoiesis was restored. The GvHD resolved in four patients, of whom one died subsequently of multiorgan failure and two died of leukemia; one is still alive. A fifth patient had transient improvement in GvHD, which recurred when the corticosteroids were reduced. Three patients obtained no benefit from the procedure. We conclude that 'rescue' by transfusion of autologous or syngeneic nucleated cells may be valuable to treat severe refractory GvHD; the best approach to conditioning remains to be defined.

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More information

Published date: December 2004
Keywords: Adult, Female, Graft vs Host Disease, Humans, Leukemia, Myeloid, Male, Middle Aged, Peripheral Blood Stem Cell Transplantation, Salvage Therapy, Transplantation Chimera, Transplantation Conditioning, Transplantation, Autologous, Transplantation, Isogeneic, Journal Article
Organisations: Cancer Sciences

Identifiers

Local EPrints ID: 411602
URI: http://eprints.soton.ac.uk/id/eprint/411602
ISSN: 0268-3369
PURE UUID: e5b2a326-5a11-425e-9b33-8d747694544c
ORCID for K Orchard: ORCID iD orcid.org/0000-0003-2276-3925

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Date deposited: 21 Jun 2017 16:31
Last modified: 16 Mar 2024 03:26

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Contributors

Author: J R Passweg
Author: K Orchard ORCID iD
Author: A Buergi
Author: A Gratwohl
Author: R Powles
Author: J Goldman
Author: J Apperley
Author: J Mehta

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