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Allogeneic bone marrow transplantations at Huddinge Hospital and strategies to improve survival.

https://arctichealth.org/en/permalink/ahliterature25379
Source
Clin Transpl. 1990;:175-87
Publication Type
Article
Date
1990
Author
O. Ringdén
J. Aschan
L. Boström
G. Dahllöf
J. Tollemar
T. Paulin
G. Gahrton
C G Groth
S. Klaesson
R. Lindquist
Author Affiliation
Department of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden.
Source
Clin Transpl. 1990;:175-87
Date
1990
Language
English
Publication Type
Article
Keywords
Adult
Bone Marrow Transplantation - immunology
Female
Follow-Up Studies
Graft vs Host Disease
Histocompatibility testing
Humans
Leukemia - surgery
Male
Metabolic Diseases - surgery
Research Support, Non-U.S. Gov't
Retrospective Studies
Sweden
Tissue Donors
Transplantation, Homologous
Abstract
At Huddinge Hospital 275 patients underwent allogeneic bone marrow transplantation. Among children in first remission of acute leukemia or chronic phase CML (early leukemia), with HLA-identical marrow the 8-year leukemia-free survival was 77%. This was better than 38% in children undergoing transplantation in second to fourth remission (p less than 0.0009). In adults with early leukemia, the 8-year leukemia-free survival was 47% compared to 21% for intermediate-risk adults (p = 0.007). Among 25 patients with severe aplastic anemia receiving marrow from HLA-identical siblings, the actuarial 10-year survival was 78%. In 14 patients with various metabolic disorders, of whom half received marrow from HLA-mismatched donors, the actuarial 7-year survival was 71%. Forty-three patients were given marrow from HLA-mismatched donors and had an increased incidence of acute graft-versus-host disease (GvHD) and death due to GvHD compared to recipients of HLA-identical bone marrow. The major causes of death among our patients were relapse of leukemia, death due to GvHD, cytomegalovirus (CMV) pneumonitis, bacterial infection and invasive fungal infections. By preventing GvHD with T-cell depletion or methotrexate (MTX) combined with cyclosporine (CsA) acute GvHD decreased, but the incidence of relapse increased compared to patients treated with MTX or CsA alone. This resulted in improved survival in patients older than 30 years, but a nonsignificant decrease in leukemia-free survival in younger patients. There was an association between herpes virus immunity in the recipient and GvHD. CMV pneumonitis increased following GvHD and decreased in patients treated with MTX combined with CsA. Invasive fungal infections may be treated or prevented using amphotericin B encapsulated in liposomes with few side effects.
PubMed ID
2103143 View in PubMed
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An ethnic role for chronic, but not acute, graft-versus-host disease after HLA-identical sibling stem cell transplantation.

https://arctichealth.org/en/permalink/ahliterature195247
Source
Transplant Proc. 2001 Feb-Mar;33(1-2):1769-70
Publication Type
Article

An ethnic role for chronic, but not acute, graft-versus-host disease after HLA-identical sibling stem cell transplantation.

https://arctichealth.org/en/permalink/ahliterature20034
Source
Eur J Haematol. 2001 Jan;66(1):50-6
Publication Type
Article
Date
Jan-2001
Author
M. Remberger
J. Aschan
B. Lönnqvist
S. Carlens
B. Gustafsson
P. Hentschke
S. Klaesson
J. Mattsson
P. Ljungman
O. Ringdén
Author Affiliation
Centre for Allogeneic Stem Cell Transplantation, and Department of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Sweden. Mats.Remberger@impi.ki.se
Source
Eur J Haematol. 2001 Jan;66(1):50-6
Date
Jan-2001
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Africa - ethnology
Aged
Anemia, Aplastic - therapy
Asia - ethnology
Child
Child, Preschool
Chronic Disease
Cytomegalovirus - growth & development
Cytomegalovirus Infections - ethnology - etiology
Europe - ethnology
Fanconi Anemia - therapy
Female
Follow-Up Studies
Graft Survival
Graft vs Host Disease - ethnology - etiology - immunology
HLA Antigens - immunology
Hematopoietic Stem Cell Transplantation - adverse effects
Histocompatibility
Humans
Incidence
Infant
Life tables
Logistic Models
Male
Metabolism, Inborn Errors - therapy
Middle Aged
Minor Histocompatibility Antigens - immunology
Multivariate Analysis
Neoplasms - therapy
Nuclear Family
Recurrence
Research Support, Non-U.S. Gov't
Risk factors
Scandinavia - ethnology
Survival Analysis
Sweden - epidemiology
Virus Activation
Abstract
Among 424 HLA identical siblings undergoing stem cell transplantation, 364 were Scandinavians and 60 represented other ethnic groups. The cumulative probabilities of acute graft-versus-host disease grades II-IV were similar in both groups, 17% in Scandinavians and 12% in the others, p = 0.4. In a multivariate analysis, less effective immune suppression with cyclosporine or methotrexate alone (p = 0.001), recipient seropositive for three to four herpes viruses (p = 0.004), CMV-seropositive recipient (p = 0.05) and early engraftment (before day 15) (p = 0.05) were independent risk-factors for acute GVHD grades II-IV. The cumulative probabilities of chronic GVHD were 47% and 68% in the two ethnic populations, respectively (p = 0.004). In multivariate analysis, higher patient age (p
PubMed ID
11168508 View in PubMed
Less detail