Allogeneic bone grafts

G. Other applications Other possible uses of Orthoclone OKT3 are for prophylaxis and treatment of acute graft-versus-host disease (as an adjunct with allogeneic bone marrow transplantation) treatment of rejection after lung transplantation prophylaxis and treatment of rejection... 

Markus, P. M., Cai, X., Ming, W., Demetris, A. j., Fung, j. j., and Starzl, T. E. (1991). FK 506 reverses acute graft-versus-host disease after allogeneic bone marrow transplantation in rats. Surgery 110, 357-364. 

Cohen J, Moore, R.H., A1 Hashimi, S., Jones, L., Apperley, J.F., Aber, V.R. Antibody titers to a rough-mutant strain of Escherichia coli in patients undergoing allogeneic bone marrow transplantation. Evidence of a protective effect against graft-versus-host disease. Lancet 1 (1987) 8-11. 

The first successful efforts to treat LSDs came in the form of allogeneic bone marrow transplants aimed at providing at least residual levels of circulating enzyme from the grafted cells of normal, closely matched donors (often a sibling or family member)[2], While bone marrow transplants remain an option for some LSDs still lacking viable therapies, they rarely achieve the necessary blood levels of enzyme and exposure for full- or long-term reversal of the disease phenotype. 

Ohlen, C., Kling, G., Hoglund, P., Hansson, M., Scangos, G., and Bieberich, C. et al. (1989). Prevention of allogeneic bone marrow graft rejection by H-2 transgene in donor mice. Science 246(4930), 666-668. 

Antin JH, Weisdorf D, Neuberg D, Nicklow R, Clouthier S, Lee SJ, Alyea E, McGarigle C, Blazar BR, Sonis S, Soiffer RJ, Ferrara JL. Interleukin-1 blockade does not prevent acute graft-versus-host disease results of a randomized, double-bhnd, placebo-controlled trial of interleukin-1 receptor antagonist in allogeneic bone marrow transplantation. Blood 2002 100(10) 3479-82. 

Because the production of cytokines (for example IL-1 or TNF-alfa) involved in the stimulation of cells responsible for graft-versus-host disease can be enhanced by hemopoietic growth factors, the use of growth factors after allogeneic transplantation is theoretically risky. However, in reviews of trials of G-CSF or GM-CSF in allogeneic bone marrow transplantation there were no increases in late engraftment failures, relapse rates, or exacerbation of graft-versus-host disease (54,61). 

Intravenous immunoglobulin administered to allogeneic bone marrow transplant recipients modifies graft-versus-host disease and prevents interstitial pneumonia and infections (14). 

Winston DJ, Antin JH, Wolff SN, Bierer BE, Small T, Miller KB, Linker C, Kaizer H, Lazarus HM, Petersen FB, Cowan MJ, Ho WG, Wingard JR, Schiller GJ, Territo MC, Jiao J, Petrarca MA, Tonetta SA. A multicenter, randomized, double-blind comparison of different doses of intravenous immunoglobulin for prevention of graft-versus-host disease and infection after allogeneic bone marrow transplantation. Bone Marrow Transplant 2001 28(2) 187-96. 

A 49-year-old man with acute myeloid leukemia underwent allogeneic bone marrow transplantation from his brother. Pre-existing pulmonary aspergillosis was treated with intravenous amphotericin. ACT scan of the chest and abdomen 120 ml of the non-ionic dimer iodix-anol was performed and 6 hours after the injection he developed generalized erythema with a pruritic painful skin rash. Skin biopsies showed changes typical of chronic graft-versus-host disease. He received prednisolone 50 mg orally and the rash resolved within a few weeks. 

A 38-year-old man with acute myeloid leukemia underwent allogeneic bone marrow transplantation from his brother. He received iopromide 120 ml during CT scanning of the chest 15 months after the transplantation and 6 hours later developed generalized erythroderma, which was treated with oral prednisolone 50 mg. The lesion persisted and cholestatic jaundice developed. Graft-versus-host disease of the skin and liver was diagnosed. The patient stiU required immunosuppressive therapy and prednisolone 18 months after the event. 

Other cases of severe neurotoxicity have been seen during tacrolimus treatment for graft-versus-host disease after allogeneic bone marrow transplantation. 

Miralbell R, Bieri S, Mermillod B, Fleig C, Sancho G, Pastoors B, Keller A, Kurtz JM, Chapuis B. Renal toxicity after allogeneic bone marrow transplantation the combined effects of total-body irradiation and graft-versus-host disease. J Clin Oncol 1996 14 579-585. 

Bone-marrow transplantation is an approved curative treatment for many hemato- and oncologic diseases. Nevertheless, the severe acute clinical course of graft-versus-host disease (GVHD) after allogeneic bone-marrow transplantation is frequently fatal, and is to date not curable. Acute GVHD must, therefore, be prevented from the start of the bone-marrow transplantation by immunosuppressive... 

Aside from its antineoplastic activity, methotrexate also has been used with benefit in the therapy of psoriasis. Additionally, it inhibits cell-mediated immune reactions and is employed as an immunosuppressive agent to suppress graft-versus-host disease in allogenic bone marrow and organ... 

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