Transplant :: New treatments fight GVHD in bone marrow transplant patients

It?s hard to imagine your body being attacked by foreign blood cells while your own immune system is unable to defend you.

Unfortunately, for many bone marrow transplant patients, graft versus host disease (GVHD) is a common and often deadly complication of this life-saving procedure.

However, research by the University of Michigan Comprehensive Cancer Center has revealed a new way to fight back against these attacks.

?When graft versus host disease occurs, it can be fatal in about 50 percent of the cases,? says James Ferrara, M.D., director of the Blood & Marrow Transplantation Program at the U-M Comprehensive Cancer Center. ?Through our research, we?ve found some of the reasons behind graft versus host involve an inflammatory reaction, and treating the inflammatory reaction may curb graft versus host.?

More than 5,000 Americans receive allogeneic bone marrow transplants annually, meaning the bone marrow donor is someone other than the patient or his identical twin.

GVHD occurs when cells from the donated bone marrow attack the body of the transplant patient, whose own immune system has been repressed in order to allow the new bone marrow to grow. Most often, it is the skin, eyes, stomach, and intestines that are affected.

Ferrara and his colleagues have found that as this immune system reaction progresses, it mimics a very large inflammation in the body, and that specific proteins are directly responsible for this inflammation.

?There are certain antidotes to these proteins. Knowing that, we have developed new trials both to treat GVHD, as well as to prevent it,? Ferarra explains.

Graft versus host disease is normally treated using high dose steroids, but only about a third of the patients respond to this treatment. However, using anti-inflammatory proteins in combination with steroids has yielded a response rate of over two-thirds, twice the traditional rate of complete response.

The researchers are particularly excited about the use of etanercept, a drug that is commonly used to reduce the inflammation of rheumatoid arthritis, to treat GVHD. ?The treatment is very simple. It?s a shot, similar to an insulin injection, that is given twice a week,? says Ferarra.

The new treatments reduce the risk of death, hospitalization and serious side effects associated with bone marrow transplants and GVHD. This means that patients who get transplants will have a much higher chance of being cured without the debilitating effects of GVHD, and also that bone marrow transplant is likely to become more available to patients who need it.


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