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To evaluate if rapamune + tacrolimus immunosuppressive prophylaxis is better than the established therapy using cyclosporine and methotrexate, a Nordic prospective multicenter randomized study will be performed. Patients will be randomized to treatment with rapamune combined with tacrolimus, or the established therapy using cyclosporine and methotrexate.
Primary endpoint The primary endpoint is grade II-IV acute GVHD in the two groups. GVHD is diagnosed clinically and graded from 0 to IV. The diagnosis is clinical and biopsies from skin, liver and gut is used according to the routines at each participating center.
Other study parameters
1. Time to neutrophils >0.5 x 109/L.
2. Time to platelets >20 x 109/L and 50 x 109/L.
3. Platelet level 30 days after transplant.
4. Transfusion requirements of platelets, erythrocytes, granulocyte transfusions during the first 30 days.
5. Non-engraftment (graft failure/rejection).
6. Grade of acute GVHD.
7. Incidence of chronic graft-versus-host disease graded as limited or extensive and mild, moderate and severe.
8. Transplant-related mortality.
9. Probability of relapse in patients with haematological malignancies.
11. Relapse-free survival.
12. Infections by bacteria, virus and fungi. Cytomegalovirus reactivation is also followed by PCR.
13. Side-effects. Side-effects regarding hematopoiesis, liver test, renal function, cardiac function, neurology, endocrinology, etc., are taken from the patients' charts. These parameters are followed regularly after transplantation.
Inclusion criteria Chronic myeloid leukemia (CML) in 1st or 2nd chronic phase, acute myeloid leukemia (AML) in complete remission, acute lymphoblastic leukemia (ALL) in complete remission, myelodysplastic syndrome, chronic lymphocytic leukemia, lymphoma, non-malignant disorders, severe aplastic anemia, hemoglobinopathies and metabolic disorders
Allocation: Randomized, Control: Active Control, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
Karolinska University Hospital
Published on BioPortfolio: 2014-08-27T03:18:45-0400
The purpose of this study is to determine if the incidence of Graft vs. Host Disease (GVHD) after non-myeloablative transplantation can be reduced by using a combination of three immune su...
To compare the effectiveness of Tacrolimus and Rapamycin to Tacrolimus and Methotrexate in the prevention of severe graft-versus-host-disease.
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A 12-KDa tacrolimus binding protein that is found associated with and may modulate the function of calcium release channels. It is a peptidyl-prolyl cis/trans isomerase which is inhibited by both tacrolimus (commonly called FK506) and SIROLIMUS.
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