Journal
BONE MARROW TRANSPLANTATION
Volume 34, Issue 6, Pages 471-476Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/sj.bmt.1704604
Keywords
sirolimus; GVHD prophylaxis; allogeneic stem cell transplantation
Categories
Funding
- NHLBI NIH HHS [P01 HL070149] Funding Source: Medline
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Sirolimus is a novel macrolide immunosuppressant widely used in solid organ transplantation. We have conducted three clinical trials using this compound as prophylaxis against GVHD after allogeneic stem cell transplantation. Our studies have demonstrated excellent GVHD control even when mismatched and unrelated donors were used. The morbidity and mortality associated with transplantation were reduced due to the omission or reduction in methotrexate dose. Furthermore, CMV reactivation and fungal infection rates were low. However, we have noted that sirolimus may be associated with increased rates of thrombotic microangiopathy after transplantation. Sirolimus has other uses, such as the treatment of established acute and chronic GVHD, and may be useful for treatment of post transplant lymphoproliferative disorder and perhaps as an antineoplastic agent against a wide variety of hematologic and solid neoplasms.
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