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T-Cells, Graft-Versus-Host Disease, and Graft-Versus-Leukemia

New Approaches for Blood and Marrow Transplantation
  • Richard Champlin
  • Sergio Giralt
  • James Gajewski
Chapter

Abstract

Allogeneic bone marrow transplantation is most commonly used as treatment for leukemia. Allotransplantation is associated with several interrelated immunologic processes, graft rejection, graft-vs-host disease and graft-vs-leukemia. Graft rejection can be overcome by intensive pretransplant immunosuppressive therapy. Following transplantation immunoreconstitution must occur from donor derived progenitors and graft-vs-host disease may occur from reactivity of donor derived immunocompetant cells against host tissues. In a related, but distinct process, donor immunocompetant cells may react against the recipient leukemia and recent data confirm that this GVL effect plays a critical role to prevent relapse post transplant. This report summarizes present data regarding the mechanism of these processes. A major challange is to separate the beneficial GVL effect from GVHD, the major complication of allogeneic marrow transplantation. In this report we summarize data regarding innovative approaches to modify the composition of the transplanted marrow to optimize clinical outcome as well as use of donor lymphocyte infusions as a means to induce graft-vs-leukemia post transplant. In this report we summarize data regarding innovative approaches to modify the composition of the transplanted marrow to optimize clinical outcome as well as use of donor lymphocyte infusions as a means to induce graft-vs-leukemia post transplant.

The biologic effects of allogeneic bone marrow transplantation depend upon the composition of the graft. The goal is to achieve engraftment and hematopoietic recovery and avoid the development of graft-versus-host disease (GVHD). For patients transplanted for leukemia, another important component is the immune mediated graft-versus-leukemia effect, important to prevent relapse.

Keywords

Bone Marrow Transplantation Chronic Myelogenous Leukemia Graft Failure Graft Rejection Acute GVHD 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Plenum Press, New york 1996

Authors and Affiliations

  • Richard Champlin
    • 1
  • Sergio Giralt
    • 1
  • James Gajewski
    • 1
  1. 1.Section of Bone Marrow Transplantation Department of Hematology Division of MedicineUniversity of Texas M.D. Anderson Cancer CenterHoustonUSA

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