Skin-Limited Graft-versus-Host Disease after Pancreatic Transplantation.
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ABSTRACT:
SUBMITTER: Ilyas M
PROVIDER: S-EPMC5540464 | biostudies-literature | 2017
REPOSITORIES: biostudies-literature
Publications
Skin-Limited Graft-versus-Host Disease after Pancreatic Transplantation.
Ilyas Muneeb M Hoss Elika E DiCaudo David J DJ Khamash Hasan H Pittelkow Mark R MR Sharma Amit A
Case reports in transplantation 20170718
<h4>Introduction</h4>The phenomenon of graft-versus-host disease, a solid organ transplant recipient, is a rare development with a very poor prognosis.<h4>Case presentation</h4>A 40-year-old woman with type 1 diabetes developed cutaneous graft-versus-host disease following second pancreas transplantation.<h4>Conclusion</h4>The development of a nonspecific rash in the early posttransplant period following a pancreas transplant warrants suspicion for graft-versus-host disease. ...[more]
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Project description:PurposeWe designed a minimal-intensity conditioning regimen for allogeneic hematopoietic cell transplantation (HCT) in patients with advanced hematologic malignancies unable to tolerate high-intensity regimens because of age, serious comorbidities, or previous high-dose HCT. The regimen allows the purest assessment of graft-versus-tumor (GVT) effects apart from conditioning and graft-versus-host disease (GVHD) not augmented by regimen-related toxicities.Patients and methodsPatients received low-dose total-body irradiation ± fludarabine before HCT from HLA-matched related (n = 611) or unrelated (n = 481) donors, followed by mycophenolate mofetil and a calcineurin inhibitor to aid engraftment and control GVHD. Median patient age was 56 years (range, 7 to 75 years). Forty-five percent of patients had comorbidity scores of ≥ 3. Median follow-up time was 5 years (range, 0.6 to 12.7 years).ResultsDepending on disease risk, comorbidities, and GVHD, lasting remissions were seen in 45% to 75% of patients, and 5-year survival ranged from 25% to 60%. At 5 years, the nonrelapse mortality (NRM) rate was 24%, and the relapse mortality rate was 34.5%. Most NRM was a result of GVHD. The most significant factors associated with GVHD-associated NRM were serious comorbidities and grafts from unrelated donors. Most relapses occurred early while the immune system was compromised. GVT effects were comparable after unrelated and related grafts. Chronic GVHD, but not acute GVHD, further increased GVT effects. The potential benefit associated with chronic GVHD was outweighed by increased NRM.ConclusionAllogeneic HCT relying on GVT effects is feasible and results in cures of an appreciable number of malignancies. Improved results could come from methods that control progression of malignancy early after HCT and effectively prevent GVHD.
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