Clinical tolerance after allogeneic hematopoietic stem cell transplantation: a study of influencing factors

Transplantation
P HentschkeOlle Ringdén

Abstract

Clinical tolerance, defined as discontinuation of immunosuppression without immunological events, is often achieved after allogeneic hematopoietic stem cell transplantation, unlike after organ transplantation. However, this phenomenon has rarely been studied. Between September 1977 and December 1997, we evaluated 354 allogeneic hematopoietic stem cell recipients who had had more than 1 year of relapse-free survival, regarding time to discontinuation of immunosuppression. Factors such as patient age, donor age, donor sex, immunosuppressive protocols, cell dose, and graft-versus-host-disease (GVHD) were studied. Patients who did not develop GVHD had discontinued immunosuppression according to the protocols, within 1 year for malignant diseases and within 2 years for nonmalignant diseases. Patients given methotrexate as a single drug were off immunosuppression faster than those given cyclosporine alone (P=0.05). Children (<18 years) discontinued immunosuppression faster than adults (P=0.05). Low donor age was of greater importance than low recipient age for early discontinuation (P=0.003). Male recipients of stem cells from immunized female donors needed a longer time to discontinuation (P<0.001). Patients without acute GVHD had a...Continue Reading

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Citations

May 24, 2003·Clinical Immunology : the Official Journal of the Clinical Immunology Society·Vanessa HowardMary Ellen Conley
Oct 31, 2003·Transplantation·Olle RingdénOuti Hovatta
Mar 2, 2006·Annals of Plastic Surgery·Selahattin OzmenMaria Siemionow

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