Allogeneic Bone Marrow Transplantation for Chronic Myeloid Leukemia Using Sibling and Volunteer Unrelated Donors: A Comparison of Complications in the First 2 Years

Marks, David I.; Cullis, Jonathan O.; Ward, Katherine N.; Lacey, Sandra; Szydlo, Richard; Hughes, Timothy P.; Schwarer, Anthony P.; Lutz, Edwin; Barrett, A. John; Hows, Jill; Batchelor, J. R.; Goldman, John M.

doi:10.7326/0003-4819-119-3-199308010-00005

Cited by 183 publications

(114 citation statements)

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“…In our experience, with genome-MUDs and the use of ATG, outcome using unrelated donors is similar to that using HLA-identical siblings. 26,27 A MUD transplant is more expensive because there are certain costs for the donor and for transportation of the transplant. In addition, MUD is more often associated with higher-risk patients and more infections, even though GVHD has not increased at our centre.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, MUD is more often associated with higher-risk patients and more infections, even though GVHD has not increased at our centre. 19,27 The source of stem cells (PBSCs, BM or cord blood) had no effect on 1-year survival. Although they enhance engraftment of ANC and plts, PBSCs have not affected discharge from hospital and have a similar incidence of acute GVHD, TRM and survival to BM grafts.…”

Section: Discussionmentioning

confidence: 99%

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Increased costs after allogeneic haematopoietic SCT are associated with major complications and re-transplantation

Remberger

Alvin

et al. 2011

Bone Marrow Transplant

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We wanted to evaluate factors associated with high costs after allogeneic haematopoietic SCT (HSCT). We collected all in-patient and outpatient costs during the first year after HSCT over 5 years, from 2003 to 2007. Mean 1-year costs per patient were h141 493 (95% confidence interval (95% CI) ¼ 125 019-157 967). Patients treated with non-myeloablative conditioning (NMC) had reduced costs, but patients treated with reduced-intensity or myeloablative conditioning had similar 1-year costs. Multivariate analysis showed that increased 1-year costs were seen in post-transplant complications: rejection (relative hazard (RH) 1.24, Po0.001), acute GVHD of grades III-IV (1.31, Po0.001) and invasive fungal infection (1.15, P ¼ 0.02). In addition, increased costs were associated with retransplantation (1.21, P ¼ 0.001), mesenchymal stem-cell therapy (1.26, Po0.001), unrelated donor transplants (1.20, P ¼ 0.002) and the need for G-CSF treatment due to poor engraftment (1.12, P ¼ 0.047). In patients without any of these risk factors, mean 1-year costs were h84 773 (95% CI ¼ 71 145-98 400) (n ¼ 51). With three risk factors, the cost increased to h249 775 (95% CI ¼ 166 824-332 727) (n ¼ 14). To conclude, major complications increased the costs of HSCT. Unrelated donor transplants were more expensive than HLAidentical sibling transplants. Costs were reduced in patients treated with NMC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Increased costs after allogeneic haematopoietic SCT are associated with major complications and re-transplantation

Remberger

Alvin

et al. 2011

Bone Marrow Transplant

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“…However, severe graft-versus-host disease (GVHD) increases morbidity and mortality for haematopoietic transplantation from alternative donors when compared to HLA-matched siblings. [1][2][3][4] Pre-graft serotherapy directed against lymphocytes has been demonstrated to reduce the risk of severe GVHD. [5][6][7] Different types of pre-graft serotherapy have been used including monoclonal antibodies such as OKT3, or Campath 1G anti-CD52, or rabbit or horse polyclonal antibodies directed against thymocytes or T lymphocytes.…”

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confidence: 99%

Immune reconstitution after haematopoietic transplantation with two different doses of pre-graft antithymocyte globulin

Duval

Pédron

Rohrlich

et al. 2002

Bone Marrow Transplant

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Summary:Antithymocyte globulin is widely used before haematopoietic transplantation with HLA-matched unrelated donors or mismatched relatives to prevent rejection and graft-versus-host disease (GVHD). However, optimal dosage is still under debate. Thirty-one consecutive children, mainly with haematological malignancies, were transplanted in a single institution with such donors, selected by HLA-A -B compatibility by serology and DRB1* by DNA typing. Antithymocyte globulin (Thymoglobuline; Sangstat) was infused at days ؊3, ؊2, ؊1. Total dosage varied: 16 patients received a median of 7.5 mg/kg (2.5 to 10.5: low-dose group), and 15 a median of 15.5 mg/kg (14.4 to 19.4: high-dose group). Post-transplant GVHD prophylaxis consisted of cyclosporine, short-course methotrexate and steroids. CD3 + , CD4 + and CD19 + cell reconstitution was slower in the high-dose group. Median time to reach 100 CD4 + cells was 8 months vs 4 months (P = 0.03). Median time to normal CD19 + cells was 16 months vs 8 months (P = 0.01). CD16 + CD56 + and CD8 + cell reconstitution was similar. Nine patients in the high-dose group and two in the low-dose group experienced life-threatening opportunistic infections (P = 0.009). Although obtained from a limited number of patients, our data suggest that a higher pre-graft dose of antithymocyte globulin may negatively influence immune reconstitution.

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“…[12][13][14] In adults, the reported incidence of cGVHD ranges between 30 and 50% of HLA-identical sibling transplant recipients, with aGVHD being recognized as the most important factor predicting the development of the chronic form of the disease. [15][16][17] The increased use of matched unrelated volunteers as donors 18 and of peripheral blood as a stem cell source 19,20 has led to a further increase of the incidence and severity of this complication.…”

Section: Discussionmentioning

confidence: 99%

Alefacept treatment for refractory chronic extensive GVHD

Shapira

Abdul-Hai

Resnick

et al. 2008

Bone Marrow Transplant

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Allogeneic Bone Marrow Transplantation for Chronic Myeloid Leukemia Using Sibling and Volunteer Unrelated Donors: A Comparison of Complications in the First 2 Years

Abstract: Results appear to justify the continued use of volunteer donors in chronic-phase chronic myeloid leukemia, but infection and chronic GVHD are still major problems.

Cited by 183 publications

References 0 publications

Increased costs after allogeneic haematopoietic SCT are associated with major complications and re-transplantation

Increased costs after allogeneic haematopoietic SCT are associated with major complications and re-transplantation

Immune reconstitution after haematopoietic transplantation with two different doses of pre-graft antithymocyte globulin

Alefacept treatment for refractory chronic extensive GVHD

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