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Graft-Versus-Host Disease

The impact of cyclosporin A on acute graft-versus-host disease after allogeneic bone marrow transplantation in children and adolescents with acute lymphoblastic leukemia

Bone Marrow Transplantation volume 36, pages 145–150 (2005)Cite this article

Summary:

Experimental and clinical data demonstrate an antileukemia effect of acute graft-versus-host disease (aGVHD). In all, 58 pediatric patients with acute lymphoblastic leukemia (ALL) who had received an allogeneic bone marrow transplant (BMT) at our institution were retrospectively analyzed for a correlation between the development of aGVHD and leukemic relapse. Probability of relapse after 5 (3) years was 13% (7%) in patients developing grade II–IV aGVHD vs 30% in patients with grade 0 or I aGVHD. There was a trend for a difference of the point estimates at 3 years, but no overall significance because of an unusual late relapse. Moreover, we analyzed the impact of cyclosporin A (CsA) on aGVHD in a subgroup of 22 children who had received a matched sibling donor (MSD) BMT. An increased dose of CsA within the first 2 weeks after BMT led to decreased occurrence and severity of aGVHD (P=0.035). The cumulative CsA dose appeared to have more impact than the average CsA whole-blood levels within the first 2 weeks and than the CsA dose given from day 15 to 40. In this subgroup, no life-threatening aGVHD or death from aGVHD occurred. In all cases (6/22), leukemic relapse was the cause of death. We therefore suggest that there is a relation between dose of CsA and relapse rate in childhood ALL transplanted from a MSD.

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Acknowledgements

We acknowledge the enormous efforts of the nurses and doctors involved in the care of our transplant patients. We appreciate the data collection and data management of Annette Broll and Elke Dammann.

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Authors and Affiliations

  1. Department of Pediatric Hematology and Oncology, Children's Hospital, Hannover Medical School (MHH), Hannover, Germany

    O Teuffel, A Schrauder, K W Sykora, M Zimmermann, K Welte & M Schrappe

  2. University Children's Hospital, Giessen, Germany

    A Reiter

  3. Children's Hospital, University Medical Center Schleswig-Holstein, Kiel, Germany

    M Schrappe

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  1. O Teuffel
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  2. A Schrauder
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  6. K Welte
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  7. M Schrappe
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Correspondence to M Schrappe.

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Teuffel, O., Schrauder, A., Sykora, K. et al. The impact of cyclosporin A on acute graft-versus-host disease after allogeneic bone marrow transplantation in children and adolescents with acute lymphoblastic leukemia. Bone Marrow Transplant 36, 145–150 (2005). https://doi.org/10.1038/sj.bmt.1705010

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