In prevention of graft-versus-host disease

Cyclodextrin complexation (See Chapter 40) can also represent a way to improve the stability and the solubility of sensitive drugs such as thalidomide. Thalidomide is currently in clinical use for the treatment and prevention of graft-versus-host disease in leukemia patients after bone marrow transplant. However, this drug is sparingly soluble in aqueous solutions (50 Kig/mL) and is readily hydrolyzed. Complexation with hydroxypropyl (3-cyclodextrin increases the solubility to 1700 Kig/mL and extends the half-life of a dilute solution from 2.1 to 4.1 h. Other vulnerable and sparingly soluble drugs stabilized by means of cyclodextrin complexation are the non-steroidal antiinflammatory drugs diclofenac, piroxicam, and indomethacin and the anthra-cycline antibiotic daunorubicin. ... 

A retrospective analysis reviewing the ontcomes of patients who nnderwent ahogeneic HSCT for severe aplastic anemia between 1978 and 1991 showed an 89% response rate (inclnding complete and partial responses). The 15-year survival rate for complete and partial responders to HSCT was 75% and 64%, respectively. Improvement in supportive care, prevention of graft-versus-host disease, and improved engraftment have further enhanced survival benefits. Considerations in deciding to treat patients with HSCT are the availability of a donor, the age of the patient, the absolute neutrophil count, and the number of transfusions received prior to transplantation. ... 

Ruutu T, Volin L, Parkkli T, et al. Cyclosporine, methotrexate, and methylprednisolone compared with cyclosporine and methotrexate for the prevention of graft-versus-host disease in bone marrow transplantation from HLA-identical sibling donor A prospective randomized study. Blood 2000 96 2391-2398. 

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. 

In a study of graft-versus-host disease prevention strategies in patients after bone marrow transplantation for aplastic anemia, a significantly higher proportion of alem-tuzumab-treated patients developed cytomegalovirus reactivation compared with control patients [139 ]. Prophylaxis with aciclovir has been recommended [143 ]. Asymptomatic laboratory positive cytomegalovirus viremia should not necessarily be considered a serious infection requiring interruption of therapy. 

Graft-versus-host disease (GVHD) is caused by the activation of donor lymphocytes leading to immune damage to the skin, gut, and fiver in the recipient. An immunosuppressive regimen is administered to prevent GVHD in recipients... 

Uses. Ciclosporin is used to prevent and treat rejection of organ transplants (kidney, liver, heart-lung) and bone marrow transplants. It may be given orally or i.v. In the context of transplantation, administration continues indefinitely and must be carefully monitored, including measurement of plasma concentration and renal function. It is generally stopped after 6 months in patients who have received a bone marrow transplant unless there is ongoing chronic graft-versus-host disease. 

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