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Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Henrik Sengeløv, University of Copenhagen, Denmark
- Second opponent: Associate Professor Kristina Carlson, Uppsala University Hospital, Sweden
- Third member and chair of the evaluation committee: Professor Erik Dissen, University of Oslo
Chair of the Defence
Professor II John Torgils Vaage, University of Oslo
Principal Supervisor
Associate Professor Tobias Gedde-Dahl, University of Oslo
Summary
For selected patients with hematological malignancies, allogeneic stem cell transplantation may be the only curative treatment. The most life-threatening- and feared complication is Graft-versus-Host Disease (GvHD) affecting approximately 50% of the patients. GvHD is classified as acute or chronic. There is an obvious unmet need to optimize GvHD prevention and treatment. Numerous GvHD risk factors are identified and different strategies may be employed to combat GvHD.
The aims of this thesis were to analyze how histocompatibility, specifically HLA-DPB1 matching between the donor and recipient, and supplementation of the GvHD prophylactic regimen with anti-thymocyte globulin (ATG) influenced the risk of GvHD, disease relapse and overall survival by retrospectively reviewing medical records. Further, to evaluate the potential prophylactic effect of extracorporeal photopheresis applied directly upon engraftment, on the GvHD incidence, prospectively and randomized.
HLA-DPB1 matched donor-patient pairs showed increased risk of relapse and significantly lower overall survival in comparison to HLA-DPB1 mismatched donor-patient pairs.
The supplementation of the GvHD prophylactic regimen with ATG to patients receiving peripheral blood mobilized and harvested stem cells from matched unrelated donors reduced the incidence of chronic GvHD from 81% to 26%.
The prospective randomized controlled trial with extracorporeal photopheresis applied directly upon engraftment, did not reduce the incidence of GvHD nor influence disease relapse in the treatment – versus the control group.
In summary, we suggest that HLA-DPB1 analysis should be included in the assessment of patient-donor pairs. Moreover, preventive ATG should be mandatory in matched unrelated donor transplantations with peripheral blood mobilized hematopoietic stem cells. Finally, preventive extracorporeal photopheresis after transplantation as employed in our study did not influence acute- or chronic GvHD incidence.
Additional information
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