Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.
GRAFT-VS-HOST DISEASE AFTER BONE MARROW TRANSPLANTATION FROM DONORS OTHER THAN HLA-IDENTICAL SIBLINGS
Hematology; 12:425-54 1990. Unique Identifier : AIDSLINE ICDB/91675403 Herve P; Cahn J-Y; Beatty PG; Dept. of Hematology, Hopital Jean Minjoz, Besancon, France
Abstract:
Allogeneic and autologous bone marrow transplantation (BMT) can provide long-term disease-free survival when used as therapy for a variety of lethal disorders. Most patients, however, lack a human leukocyte antigen (HLA)-identical sibling and indications for autologous rescue are restricted. The possible extension of BMT to a larger group of patients has been investigated; results show that donors other than genotypically identical siblings may be used successfully for severe combined immunodeficiency disease, aplastic anemia, or leukemia, but with a higher incidence of lethal graft-vs-host disease (GVHD) and graft failure than after HLA-identical BMT. GVHD after BMT from donors other than HLA-identical siblings is reviewed, including historical aspects; GVHD and mismatched BMT (predictive factors, GVHD prophylaxis by T-cell depletion, and problems related to T-cell depletion); BMT using donors other than HLA-identical siblings (mismatched BMT from related donors, BMT from fully matched or partially mismatched unrelated volunteer donors); and prevention of complications after HLA-incompatible BMT (prevention and treatment of acute GVHD and prevention of the host-vs-graft reaction). Clearly, in situations of HLA incompatibility, GVHD, graft rejection, or relapse are closely linked and all the protocols proposed for the treatment and prevention of GVHD must be adapted to this reality. In HLA-incompatible (family donor) or phenotypically identical (unrelated) situations, a protocol for the prophylaxis and treatment of acute GVHD might be worked out on the basis of the present state of knowledge as well as on certain hypotheses to combine (1) more selective partial T-cell depletion; (2) optimal B-cell depletion in the graft when donor is positive for Epstein-Barr virus; (3) intensified radio-chemotherapeutic protocols; and (4) treatment of the recipient with in vivo monoclonal antibodies specific for residual, radio-resistant immunocompetent cells, prior to grafting. To promote better engraftment following T-cell depletion, or in mismatching, the usefulness of incubating donor marrow with recombinant growth factors (eg, granulocyte-macrophage colony-stimulating factor) is under investigation. (104 Refs)
Keywords: Anemia, Aplastic/IMMUNOLOGY Bone Marrow Transplantation/*IMMUNOLOGY Graft vs Host Disease/GENETICS/*IMMUNOLOGY/MORTALITY Graft Rejection/GENETICS/IMMUNOLOGY Histocompatibility Antigens/GENETICS/*IMMUNOLOGY *Histocompatibility Testing Human Immunologic Deficiency Syndromes/IMMUNOLOGY Leukemia/IMMUNOLOGY Lymphocyte Depletion Risk Factors Survival Rate T-Lymphocyte Subsets/IMMUNOLOGY MONOGRAPH REVIEW 911030
M91A1129
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Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.
