Novel And Improved Methods For The Prevention And Treatment Of Graft Versus Host Disease Gvhd

This book is open access under a CC BY 4.0 license. This textbook, endorsed by the European Society for Blood and Marrow Transplantation (EBMT), provides adult and paediatric nurses with a full and informative guide covering all aspects of transplant nursing, from basic principles to advanced concepts. It takes the reader on a journey through the history of transplant nursing, including essential and progressive elements to help nurses improve their knowledge and benefit the patient experience, as well as a comprehensive introduction to research and auditing methods. This new volume specifically intended for nurses, complements the ESH-EBMT reference title, a popular educational resource originally developed in 2003 for physicians to accompany an annual training course also serving as an educational tool in its own right. This title is designed to develop the knowledge of nurses in transplantation. It is the first book of its kind specifically targeted at nurses in this specialist field and acknowledges the valuable contribution that nursing makes in this area. This volume presents information that is essential for the education of nurses new to transplantation, while also offering a valuable resource for more experienced nurses who wish to update their knowledge.

Chronic graft versus host disease (GVHD) is the most common complication of allogenic bone marrow transplantation. Because of the protracted clinical course of chronic GVHD, transplant centers and hematology/oncology offices are inadequately equipped to manage these immuno-incompetent patients with a multi-system disorder. Practitioners need to be able to recognize and effectively manage chronic GVHD as a late effect of more than half of allogenic transplantations. The text is oriented for the clinician, with chapters covering staging, organ site and system-specific manifestations, treatment options, and supportive care. Drs Georgia B. Vogelsang and Steven Z. Pavletic have been pioneers in the recognition of the multi-organ complexity of this disease and have gathered the input of a variety of subspecialist physicians for this book. This book fills the gap in practical literature on chronic GVHD, providing a comprehensive, up-to-date, and clinically relevant resource for anyone who deals with cancer patients post-transplant.

This Open Access edition of the European Society for Blood and Marrow Transplantation (EBMT) handbook addresses the latest developments and innovations in hematopoietic stem cell transplantation and cellular therapy. Consisting of 93 chapters, it has been written by 175 leading experts in the field. Discussing all types of stem cell and bone marrow transplantation, including haplo-identical stem cell and cord blood transplantation, it also covers the indications for transplantation, the management of early and late complications as well as the new and rapidly evolving field of cellular therapies. This book provides an unparalleled description of current practices to enhance readers' knowledge and practice skills. This work was published by Saint Philip Street Press pursuant to a Creative Commons license permitting commercial use. All rights not granted by the work's license are retained by the author or authors.

"Objective: Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic cell transplantation (AHCT). We investigated whether the Center for International Blood and Marrow Transplant Research registry could be useful for (1) determining if the sequence of administering non-specific, highly T-lymphodepleting (NHTL) therapeutics in GVHD prophylaxis and in refractory GVHD impacts survival and (2) identifying donor- and patient-related factors that may guide individualized selection of classes of immunosuppressant agents over time, i.e. to develop adaptive treatment strategies (ATSs).Method: We employed a backwards induction method derived from reinforcement learning in a large cohort of patients who underwent AHCT for acute myeloid leukemia and myelodysplasia between 1995 and 2007. We devised logistic Q-models that first estimate the optimal treatment for each patient with refractory acute GVHD and then use a pseudo-outcome approach to estimate the optimal patient-specific GVHD prophylaxis, with the goal of maximizing 2-year disease-free survival (DFS).Results: In unadjusted analysis, NHTL prophylaxis and NHTL treatment of refractory acute GVHD were associated with inferior DFS compared to non-NHTL therapeutics. Yet, among the 9563 patients, the Q-model predicted that 4762 (50%) would have a higher probability of 2-year DFS with NHTL prophylaxis. For the 1411 patients with refractory acute GVHD, the Q-model predicted that 492 (35%) would have had a higher probability of 2-year DFS with NHTL salvage therapy. The magnitude of projected patient-specific benefit from choosing the optimal class of agent was modest. The models suggested that patient-specific combinations of characteristics could influence the choice of GVHD prophylaxis and treatment.Conclusions: Retrospective analysis with Q-learning can be used to propose personalized ATSs for GVHD prevention and treatment, which may then be tested in sequentially-randomized clinical trials. An important limitation which threatens the validity of the registry-derived strategies is that lack of detailed information about the indication for each immunosuppressant and other salient patient characteristics may lead to residual confounding." --

Bone Marrow transplantation or Hematopoietic stem cell transplantation is a life saving procedure in a number of diseases,hematological and non hematological, which fail alternative medical management or have no other treatment options. It has transformed the lives of thousands of patients and their families around the world battling with fatal or debilitating diseases.There are many unique aspects of bone marrow transplantation which makes it very different from solid organ transplants. There is an enormous amount of research going on in this field both at clinical and basic science levels.With the rapidly changing world and field of transplantation, there is a need for an authoritative and up to date resource for transplant professionals. This book titled Contemporary Bone Marrow Transplantation aims to be a reference text comprehensively covering various facets of hematopoietic stem cell transplants with latest insights about the technique and basic science behind it . The book is the product of collective effort of transplant professionals round the world, and will reflect their experience as well as the current standard of care practices in Stem cell transplantation.The book will be divided into different sections focusing on the basic science of bone marrow transplant, the technical aspects of the procedure itself and the supportive care of transplant patients.There will also be a section each on epidemiology, upcoming trends and also case studies , which will discuss real case scenarios from the experience of the authors, to illustrate the practical challenges in managing bone marrow transplant recipients.

This atlas provides trainees and practicing physicians a visual toolkit to help recognize and manage this difficult condition appropriately. This text highlights the clinical variability of GVHD, and arms readers with the diagnostic clues to categorize patients according to the current grading/staging guidelines. Furthermore, this atlas offers evidence-based diagnostic and treatment algorithms for physicians to use while at patients' bedsides.