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Combination graft-versus-host disease prophylaxis using immunotoxin (anti-CD5-RTA [Xomazyme-CD5]) plus methotrexate and cyclosporine or prednisone after unrelated donor marrow transplantation.
Bone Marrow Transplant. 1993 Nov; 12(5):531-6.BM

Abstract

Unrelated donor (URD) bone marrow transplantation (BMT) is associated with more frequent and more therapy-resistant graft-versus-host disease (GVHD). We tested an in vivo immunotoxin with direct cytolytic potency against CD5-expressing T lymphocytes (Xomazyme-CD5) for GVHD prophylaxis after URD BMT. The immunotoxin was given in vivo (0.1 mg/kg/day) for 3 weeks following transplantation in combination with methotrexate+prednisone (MXP; n = 16) or methotrexate+cyclosporine (MCX; n = 6). The 22 patients (10 phenotypically matched with their donors and 12 partially matched) received unmanipulated marrow. MXP was well tolerated, while MCX led to unacceptable nephrotoxicity, weight gain and edema. Four patients died of early complications. Thirteen of 17 evaluable patients achieved myeloid engraftment by 17-40 days (median 24 days). Acute GVHD developed in 9 of 15 evaluable patients (5 grade III/IV). Six of 8 evaluable patients developed chronic GVHD. Four patients survive 1.1-2 years after BMT. Although this immunotoxin has previously shown potency in prophylaxis of murine GVHD and therapy of human GVHD, in this trial inadequate immunosuppressive potency of the immunotoxin combinations was associated with unacceptable clinical toxicity. Aggressive immunoprophylaxis against GVHD is required to improve the success of URD BMT.

Authors+Show Affiliations

Department of Medicine, University of Minnesota, Minneapolis 55455.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

8298565

Citation

Weisdorf, D, et al. "Combination Graft-versus-host Disease Prophylaxis Using Immunotoxin (anti-CD5-RTA [Xomazyme-CD5]) Plus Methotrexate and Cyclosporine or Prednisone After Unrelated Donor Marrow Transplantation." Bone Marrow Transplantation, vol. 12, no. 5, 1993, pp. 531-6.
Weisdorf D, Filipovich A, McGlave P, et al. Combination graft-versus-host disease prophylaxis using immunotoxin (anti-CD5-RTA [Xomazyme-CD5]) plus methotrexate and cyclosporine or prednisone after unrelated donor marrow transplantation. Bone Marrow Transplant. 1993;12(5):531-6.
Weisdorf, D., Filipovich, A., McGlave, P., Ramsay, N., Kersey, J., Miller, W., & Blazar, B. (1993). Combination graft-versus-host disease prophylaxis using immunotoxin (anti-CD5-RTA [Xomazyme-CD5]) plus methotrexate and cyclosporine or prednisone after unrelated donor marrow transplantation. Bone Marrow Transplantation, 12(5), 531-6.
Weisdorf D, et al. Combination Graft-versus-host Disease Prophylaxis Using Immunotoxin (anti-CD5-RTA [Xomazyme-CD5]) Plus Methotrexate and Cyclosporine or Prednisone After Unrelated Donor Marrow Transplantation. Bone Marrow Transplant. 1993;12(5):531-6. PubMed PMID: 8298565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination graft-versus-host disease prophylaxis using immunotoxin (anti-CD5-RTA [Xomazyme-CD5]) plus methotrexate and cyclosporine or prednisone after unrelated donor marrow transplantation. AU - Weisdorf,D, AU - Filipovich,A, AU - McGlave,P, AU - Ramsay,N, AU - Kersey,J, AU - Miller,W, AU - Blazar,B, PY - 1993/11/1/pubmed PY - 1993/11/1/medline PY - 1993/11/1/entrez SP - 531 EP - 6 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 12 IS - 5 N2 - Unrelated donor (URD) bone marrow transplantation (BMT) is associated with more frequent and more therapy-resistant graft-versus-host disease (GVHD). We tested an in vivo immunotoxin with direct cytolytic potency against CD5-expressing T lymphocytes (Xomazyme-CD5) for GVHD prophylaxis after URD BMT. The immunotoxin was given in vivo (0.1 mg/kg/day) for 3 weeks following transplantation in combination with methotrexate+prednisone (MXP; n = 16) or methotrexate+cyclosporine (MCX; n = 6). The 22 patients (10 phenotypically matched with their donors and 12 partially matched) received unmanipulated marrow. MXP was well tolerated, while MCX led to unacceptable nephrotoxicity, weight gain and edema. Four patients died of early complications. Thirteen of 17 evaluable patients achieved myeloid engraftment by 17-40 days (median 24 days). Acute GVHD developed in 9 of 15 evaluable patients (5 grade III/IV). Six of 8 evaluable patients developed chronic GVHD. Four patients survive 1.1-2 years after BMT. Although this immunotoxin has previously shown potency in prophylaxis of murine GVHD and therapy of human GVHD, in this trial inadequate immunosuppressive potency of the immunotoxin combinations was associated with unacceptable clinical toxicity. Aggressive immunoprophylaxis against GVHD is required to improve the success of URD BMT. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/8298565/Combination_graft_versus_host_disease_prophylaxis_using_immunotoxin__anti_CD5_RTA_[Xomazyme_CD5]__plus_methotrexate_and_cyclosporine_or_prednisone_after_unrelated_donor_marrow_transplantation_ L2 - http://www.diseaseinfosearch.org/result/7171 DB - PRIME DP - Unbound Medicine ER -