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Graft-Versus-Host Disease

Cyclosporine is required to prevent severe acute GVHD following T-cell-depleted peripheral blood stem cell transplantation

Bone Marrow Transplantation volume 31, pages 783–788 (2003)Cite this article

Summary:

Reduced immunosuppression may improve immune recovery and increase the graft-versus-leukemia effect after allogeneic stem cell transplantation. Furthermore, the requirement for post-transplant immunosuppression following extensive T-cell depletion remains unclear. We therefore evaluated the role of cyclosporine (CSA) in recipients of HLA-identical T-cell-depleted peripheral blood stem cell transplants (PBSCT), followed by donor lymphocyte infusions (DLIs) scheduled on days +45 and +100. Before day+45, successive cohorts of patients received decreasing amounts of CSA: standard-dose (SD) CSA, low-dose (LD) CSA, or no CSA until day+45. LD CSA was as effective as SD CSA in preventing acute graft-versus-host disease (GVHD). However, moderate-to-severe acute GVHD was significantly more frequent before the day +45 DLI in patients receiving no CSA (33.3 vs 12.7%, P=0.036, including the only four grade III–IV cases). As a result of higher rates of early acute GVHD, more patients in the ‘no CSA’ group failed to receive any DLI (30.7 vs 7.1%, P=0.01). Overall, there was no difference in the incidence of acute GVHD, as patients receiving CSA developed more GVHD after DLI. Similarly, no significant differences were found in chronic GVHD, transplant-related mortality, or survival. These results define a role for CSA in preventing GVHD at low T-cell doses following PBSCT.

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Acknowledgements

We thank the stem cell transplant team and especially our transplant coordinators, Sheila Phang RN and Adeira Greene RN, for their dedicated care of our patients and their constant support of the program, and Dr Ronald Gress for providing antibodies for T-cell depletion. We also thank the Intensive Care Unit for their exemplary patient care.

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Authors and Affiliations

  1. Stem Cell Allotransplantation Section, Hematology Branch, NHLBI, National Institutes of Health, Bathesda, MD, USA

    S R Solomon, R Nakamura, R Childs, C E Dunbar, N S Young & A J Barrett

  2. Department of Transfusion Medicine, Cell Processing Section, National Institutes of Health, Bathesda, MD, USA

    E J Read, S F Leitman & C Carter

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  1. S R Solomon
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  2. R Nakamura
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  3. E J Read
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  8. N S Young
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Solomon, S., Nakamura, R., Read, E. et al. Cyclosporine is required to prevent severe acute GVHD following T-cell-depleted peripheral blood stem cell transplantation. Bone Marrow Transplant 31, 783–788 (2003). https://doi.org/10.1038/sj.bmt.1703928

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