Increased risk of leukemia relapse with high dose cyclosporine after allogeneic marrow transplantation for acute leukemia: 10 year follow-up of a randomized study

Bacigalupo, Andrea; Lamparelli, Teresa; Gualandi, Francesca; Bregante, Stefania; Raiola, Anna Maria; Grazia, Carmen Di; Dominietto, Alida; Romagnani, Chiara; Occhini, D; Frassoni, Francesco; Lint, Maria Teresa Van

doi:10.1182/blood.v98.10.3174

Cited by 77 publications

(85 citation statements)

References 2 publications

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“…It can be prevented by selected methods, but often at the expense of an increased risk of relapse, rejection or delayed immune reconstitution. [1][2][3] Hence, no optimal or even satisfactory prevention and treatment method can be defined. To advance our knowledge and define optimal approaches, correct information on the value of different strategies and methods in GVHD prevention and treatment is essential.…”

Section: Introductionmentioning

confidence: 99%

Prophylaxis and treatment of GVHD: EBMT–ELN working group recommendations for a standardized practice

Ruutu

Gratwohl

Witte

et al. 2013

Bone Marrow Transplant

261

216

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working group of the European Group for Blood and Marrow Transplantation (EBMT) and the European LeukemiaNet (ELN) GVHD remains the major impediment to broader application of allogeneic haematopoietic SCT. It can be prevented completely, but at the expense of other complications, rejection, relapse or delayed immune reconstitution. No optimal prevention or treatment method has been defined. This is reflected by enormous heterogeneity in approaches in Europe. Retrospective comparisons between different policies, although warranted, do not give definite answers. In order to improve the present situation, an European Group for Blood and Marrow Transplantation and the European LeukemiaNet working group has developed in a Delphilike approach recommendations for prophylaxis and treatment of GVHD in the most common allogeneic transplant setting, transplantation from an HLA-identical sibling or unrelated donor for standard risk malignant disease. The working group proposes these guidelines to be adopted as routine standard in transplantation centres and to be used as comparator in systematic studies evaluating the advantages and disadvantages of practices differing from these recommendations.

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Section: Introductionmentioning

confidence: 99%

Prophylaxis and treatment of GVHD: EBMT–ELN working group recommendations for a standardized practice

Ruutu

Gratwohl

Witte

et al. 2013

Bone Marrow Transplant

261

216

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“…7,8,11 Therefore, one therapeutic option would be to modulate GVHD in vivo because past studies have shown a significant impact on leukemia relapse with low-dose CYA. 12 The limitations of this study include its retrospective analysis, the low number of patients, the lack of data about DLI, GVH status, the heterogeneity of treatments prior transplantation and possible inherent bias in patients who have been referred for transplantation.…”

Section: P-valuementioning

confidence: 99%

Treatment of adult ALL with central nervous system involvement at diagnosis using autologous and allogeneic transplantation: a study from the Société Française de Greffe de Moelle et de Thérapie Cellulaire

Chantepie

Mohty

Tabrizi

et al. 2012

Bone Marrow Transplant

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To assess the role of hematopoietic SCT (HSCT) in adult ALL patients with central nervous system involvement at diagnosis, we retrospectively analyzed 90 patients who underwent autologous HSCT (auto-HSCT group; n ¼ 27) or allogeneic HSCT (allo-HSCT group; n ¼ 63) and reported to the Socié té Franc¸aise de Greffe de Moelle et de Thé rapie Cellulaire registry between 1994 and 2008. At the time of transplantation, 67 patients (74%) were in first CR, 15 (17%) in CRX2 and 8 (9%) with progressive disease. The 5-year probabilities of overall survival (OS) and disease-free survival (DFS) were 52% and 46% for the allo-HSCT and 37% and 33% for the auto-HSCT groups, respectively (P ¼ NS). The TRM at 5 years was 29.8% for the allo-HSCT group and 3.7% for the auto-HSCT group. Using univariate analysis, a time for transplantation of o12 months, the remission status at transplantation, the use of high-dose TBI and the number of the transplant were all determined to be prognostic factors for improved DFS and OS probabilities.Using multivariate analysis, we demonstrated that both the use of high-dose TBI and the remission status had a favorable impact on OS. Although the DFS and OS were better in the allo-HSCT group, the differences were not statistically significant.

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“…18 The influence of IST on risk of relapse after HCT has been examined in several studies. The combination of methotrexate and cyclosporine compared with either methotrexate or cyclosporine alone 19 and prophylactic regimens using high doses of cyclosporine 20,21 have been associated with an increased risk of relapse in certain groups of patients. Likewise, mycophenolate mofetil added to initial treatment for chronic GVHD appeared to increase the risk of relapse.…”

Section: Introductionmentioning

confidence: 99%

Influence of immunosuppressive treatment on risk of recurrent malignancy after allogeneic hematopoietic cell transplantation

Inamoto

Flowers

Lee

et al. 2011

Blood

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This study was conducted to elucidate the influence of immunosuppressive treatment (IST) and GVHD on risk of recurrent malignancy after allogeneic hematopoietic cell transplantation (HCT). The study cohort included 2656 patients who received allogeneic HCT after highintensity conditioning regimens for treatment of hematologic malignancies. Rates and hazard ratios of relapse and mortality were analyzed according to GVHD and IST as time-varying covariates. Adjusted Cox analyses showed that acute and chronic GVHD were both associated with statistically similar reductions in risk of relapse beyond 18 months after HCT but not during the first 18 months. In patients with GVHD, resolution of GVHD followed by withdrawal of IST was not associated with a subsequent increase in risk of relapse. In patients without GVHD, withdrawal of IST was associated with a reduced risk of relapse during the first 18 months, but the risk of subsequent relapse remained considerably higher than in patients with GVHD. In summary, the association of GVHD with risk of relapse changes over time after HCT. In patients without GVHD, early withdrawal of IST might help to prevent relapse during the first 18 months, but other interventions would be needed to prevent relapse at later time points. (Blood. 2011;118(2): 456-463)

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Increased risk of leukemia relapse with high dose cyclosporine after allogeneic marrow transplantation for acute leukemia: 10 year follow-up of a randomized study

Cited by 77 publications

References 2 publications

Prophylaxis and treatment of GVHD: EBMT–ELN working group recommendations for a standardized practice

Prophylaxis and treatment of GVHD: EBMT–ELN working group recommendations for a standardized practice

Treatment of adult ALL with central nervous system involvement at diagnosis using autologous and allogeneic transplantation: a study from the Société Française de Greffe de Moelle et de Thérapie Cellulaire

Influence of immunosuppressive treatment on risk of recurrent malignancy after allogeneic hematopoietic cell transplantation

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