Oral Cyclosporin A (CyA) was given for the prophylaxis of graft-versus-host disease (GVHD) to sixty-seven patients receiving a bone marrow transplant, and was found to be extremely effective in reducing the severity of acute GVHD. Side-effects of CyA included hypertrichosis, gum hypertrophy, and a rare but serious 'capillary leak' syndrome.
High dose methyl prednisolone (HDMP) was used to treat 25 episodes of graft versus host disease (GVHD) in 13 patients after bone marrow transplantation for aplastic anaemia or acute leukemia. All patients showed rapid improvement of GVHD following HDMP with resolutions of gut and skin manifestations over several days, but liver GVHD was less responsive to treatment. The major complication of treatment was infection and four patients died from infection following HDMP. The mode of action of HDMP may be a nonspecific anti-inflammatory effect but it appears to be rapidly effective in controlling GVH reactions.
After bone marrow grafting, severe unexplained thrombocytopenia and granulocytopenia may complicate the post-graft recovery of the patient. The present study has shown the presence of antibodies to platelets and granulocytes of donor origin in recipients of both allogeneic and autologous bone marrow grafts. In the case of autografts, such antibodies are by definition autoantibodies, and similar antibodies after allografting may also have an autoimmune origin. It is likely that this is the result of transient immune system imbalance, common to both allo- and autografts, in the early post-graft period. The extent to which these antibodies affect the peripheral counts probably depends on the ability of the engrafted marrow to compensate for the rate of antibody-mediated cell destruction.
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