Prophylaxis and treatment for graft-versus-host disease

摘要

Graft-versus-host disease (GVHD) continues to be a major complication after allogeneic bone marrow transplantation (BMT), especially with the increasing use of matched unrelated or mismatched related donors Immunosuppressants play an important role in the control of GVHD. We summarize our experience of the prophylaxis and treatment of GVHD. We experienced 41 allogeneic transplantations out of 77 hematopoietic stem cell transplantations in our department from January 1986 to April 2000. Among 24 matched-related transplants, 15 patients (62.5%) had acute GVHD (aGVHD), five patients (21%) had grade II-IV aGVHD (4 grade II, 1 grade III). Among 17 matched unrelated or mismatched related transplants, 13 patients (76.5%) had aGVHD and seven patients (41.2%) had grade II-IV aGVHD (five grade II, one grade III, and one grade IV). More intensive immunosuppression supported matched unrelated or mismatched related transplants to lead the long survival. Simultaneously, however, the intensive immunosuppression resulted in the increased risks for the severe infection or multiple organ failure (MOF). So establishment of appropriate immunosuppression would be required for the management of high-risk transplantation for the refractory hematological disorder.