摘要:

This review focuses on recent developments in allogeneic hematopoietic stem cell transplantation in which improved understanding and control of immune modulation have led to nonmyeloablative conditioning regimens to establish allografts. By relying on a graft-versus-tumor effect for tumor eradication, these innovative approaches reduce the toxicity barrier posed by standard allogeneic transplantation. Consequently, they can be applied to a broader population of patients including older patients with hematologic malignancies and patients with diseases not traditionally treated with allogeneic transplantation, but who may potentially benefit or be cured by an allogeneic graft-versus-tumor effect.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Hematopoietic cell transplantation using disparate related or volunteer unrelated donors is associated with substantial allogeneic complications. DNA technology, enabling discrimination at the allelic level for class I and II human leukocyte antigens, has helped us better understand these complications. Recent information demonstrates that better donor matching, more intensive conditioning regimens, and improved prevention and management of allogeneic complications can improve outcome. Many diseases that have been previously treated with related matched hematopoietic cell transplantation are now undergoing mismatched related and volunteer unrelated donor hematopoietic cell transplantation. Outcome, especially for patients with suitable donors and satisfactory prognostic features, compares favorably with outcome from matched related donors, though further improvement is required.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Obliterative bronchiolitis is a histologic diagnosis of dense eosinophilic fibrous submucosal plaques in the membranous and respiratory bronchioles. It results from repeated injury, acute rejection, infection, and other inflammatory reactions. These features lead to airway epithelial damage, followed by an exaggerated healing response. There is a build-up of mesenchymal cells and collagen fibers in the lumen which results in fibrosis and partial or total obliteration of the airways. The role of immunologic factors in this process is discussed.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Although transplantation of isolated lung tissue was first attempted in 1963, it was not until 1983 that Cooperet al.performed the first successful single lung transplant operation. Short-term survival has improved with time, but bronchiolitis obliterans hinders long-term success. Bronchiolitis obliterans syndrome (BOS) was the term assigned for allograft dysfunction not explained by acute problems. Although BOS has a variable rate of progression, treatment in general has been unsatisfactory. As an entity, BOS is the single leading cause of death 1 or more years after lung transplant, based on United Network for Organ Sharing data. The incidence of the disease has been reported at 15 to 20% per year in patients posttransplantation, and in up to 75% of surviving patients by 5 years posttransplantation. This common and devastating complication is the target of these reviews. This article will deal with risk factors for BOS and some markers for disease activity that might predict development and progression of the disease.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Sixteen years after its first description, obliterative bronchiolitis (OB) remains the dominant cause of morbidity and mortality in long-term survivors of lung transplantation. Current preventative and therapeutic strategies focus on risk factor identification and management. Acute pulmonary allograft rejection has been identified as the major risk factor for the development of OB, but to date, only one adequately powered multicenter, randomized trial has been initiated to investigate the role of alternative immunosuppressive agents in preventing OB. A further two trials are planned to commence in the latter half of 2000. When mature data from these three trials are available, the respective roles of mycophenolate mofetil, tacrolimus and rapamycin should be clarified. Similarly, only one multicenter, international, randomized placebo–controlled trial for the prevention of OB in high-risk patients and one randomized study into the efficacy of therapy for established bronchiolitis obliterans syndrome have commenced. Both of these studies employ RAD (rapamycin derivative, Novartis Pharmaceuticals, Basel, Switzerland). Single-center studies have examined the utility of tacrolimus-mycophenolate-methotrexate-cyclophosphamide-cytolytic therapy with muromonab-CD3 (OKT3) or antithymocyte globulin (ATG), photopheresis, plasmapheresis, and total lymphoid irradiation. The multiplicity of agents tried underscores their lack of universal efficacy, and speaks strongly in favor of adequately powered trials to guide management. Retransplantation remains the only cure for established, severe OB.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The pathogenesis of obliterative bronchiolitis and bronchiolitis obliterans syndrome is believed to involve alloimmune and nonimmune factors. Therefore, immunosuppressive medications given either as part of the initial regimen after lung transplantation, or for recipients with recurrent or refractory acute lung rejection, might reasonably be expected to delay or prevent the later development of these complications. The use of antilymphocyte antibody therapy, preferential treatment with tacrolimus over cyclosporine A, and substitution of mycophenolate mofetil for azathioprine have all been evaluated favorably as initial immunosuppressive therapy, but definitive evidence of superiority for any of these approaches is lacking at present. For patients with recurrent or refractory acute rejection, changing cyclosporine A to tacrolimus and addition of low-dose methotrexate to the immunosuppressive regimen have been found to be of benefit. Approaches which are currently being evaluated to prevent the development of bronchiolitis obliterans include the use of rapamycin and related compounds, local administration of immunosuppressive medications, and photopheresis.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID