Based on the assumption that FTE is a result of immunologic mechanisms either classical (e.g., marrow graft rejection) or nonclassical (e.g. genetic resistance or autoimmunity), there are two approaches to the problem of FTE. The 'selective' approach utilizes clinical and laboratory parameters to predict which AA patients will suffer FTE so that they may be prepared with more intensive immunosuppressive therapy. The 'nonselective' approach prepares all patients with the more intensive therapy. Unnecessary toxicities due to intensive therapy for those patients likely to have SME may be avoided by employing the selective approach. We are currently pursuing the following policy: (1) all untransfused, nonpregnant AA patients receive CY alone; (2) all other AA patients have an average 12-hr PI determined and those below cutoff receive CY-TBI and those above the cutoff receive CY alone in preparation for BMT. If black AA patients continue to suffer FTE despite an average 12-hr PI above the cutoff, we shall prepare all black patients with CY-TBI in the future.
|Original language||English (US)|
|Number of pages||5|
|State||Published - Dec 1 1981|
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