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Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression.

Publication ,  Journal Article
Sullivan, KM; Shulman, HM; Storb, R; Weiden, PL; Witherspoon, RP; McDonald, GB; Schubert, MM; Atkinson, K; Thomas, ED
Published in: Blood
February 1981

Fifty-two of 175 (30%) survivors of allogeneic marrow transplantation developed chronic graft-versus-hose diseases (GVHD). Five with limited chronic GVHD had an indolent clinical course with involvement of only the skin and liver. Forty-seven with extensive chronic GVHD had an unfavorable multiorgan disorder that resembled several autoimmune diseases. Thirteen patients with extensive disease (group I) were not treated and only 2 survive with Karnofsky scores >- 70%. Mortality resulted from infections and morbidity from sica syndrome, pulmonary and hepatic insufficiency, scleroderma-like skin disease, and contractures. Another 13 (group II) received a median of 8 mo prednisone and/or a brief course of antithymocyte globulin, and 3 survive without disability. The other 21 (group III) were treated with a combination of prednisone (1.0 mg/kg/q.o.d.) and either cyclophosphamide, procarbazine, or azathioprine (all 1.5 mg/kg/day) for a median of 13 mo. Combination therapy was well tolerated with only modest myelotoxicity. Fifteen in group III had a good and 4 a fair response to treatment while 2 with no response died. Azathioprine and prednisone was the most effective regimen. All therapy has been discontinued in 12 group III patients: GVHD returned in 5 (including 2 who died in spite of retreatment) while 7 remain free of GVHD for a median of 11 (range 6-30) mo observation. Only I group III survivor is disabled and 16 of the original 21 are alive 2-4 yr after transplant with Karnofsky scores of 70%-100%. Thus, combination immmunosuppression appears to favorably affect and, in some cases, premanently arrest the adverse natural course of extensive chronic GVHD.

Duke Scholars

Published In

Blood

ISSN

0006-4971

Publication Date

February 1981

Volume

57

Issue

2

Start / End Page

267 / 276

Location

United States

Related Subject Headings

  • Transplantation, Homologous
  • Prednisone
  • Immunology
  • Humans
  • Graft vs Host Reaction
  • Follow-Up Studies
  • Drug Therapy, Combination
  • Chronic Disease
  • Bone Marrow Transplantation
  • Azathioprine
 

Citation

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MLA
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Sullivan, K. M., Shulman, H. M., Storb, R., Weiden, P. L., Witherspoon, R. P., McDonald, G. B., … Thomas, E. D. (1981). Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression. Blood, 57(2), 267–276.
Sullivan, K. M., H. M. Shulman, R. Storb, P. L. Weiden, R. P. Witherspoon, G. B. McDonald, M. M. Schubert, K. Atkinson, and E. D. Thomas. “Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression.Blood 57, no. 2 (February 1981): 267–76.
Sullivan KM, Shulman HM, Storb R, Weiden PL, Witherspoon RP, McDonald GB, et al. Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression. Blood. 1981 Feb;57(2):267–76.
Sullivan KM, Shulman HM, Storb R, Weiden PL, Witherspoon RP, McDonald GB, Schubert MM, Atkinson K, Thomas ED. Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression. Blood. 1981 Feb;57(2):267–276.

Published In

Blood

ISSN

0006-4971

Publication Date

February 1981

Volume

57

Issue

2

Start / End Page

267 / 276

Location

United States

Related Subject Headings

  • Transplantation, Homologous
  • Prednisone
  • Immunology
  • Humans
  • Graft vs Host Reaction
  • Follow-Up Studies
  • Drug Therapy, Combination
  • Chronic Disease
  • Bone Marrow Transplantation
  • Azathioprine