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Pan T-cell depletion

Negative selection Positive (CD34+ cell) selection

Decreased GVHD but increased relapse rate, engraftment failure

Decreased GVHD but increased relapse rate, engraftment failure. Possible protection from PTLD by B-cell depletion

Selective T-cell depletion

CD8+ cell depletion (bone narrow)

Decreased GVHD, apparent preservation of GVL effect but increased engraftment failure

GVHD, graft-versus-host disease; CYA, cyclosporine; MMF, mycophenolate mofetil; GVL, graft-versus-leukemia.

GVHD, graft-versus-host disease; CYA, cyclosporine; MMF, mycophenolate mofetil; GVL, graft-versus-leukemia.

In combination with tacrolimus and methotrexate, or tacrolimus alone, a very low incidence of acute GVHD has been reported following HLA-matched unrelated donor transplantation and HLA-matched related donor transplantation, respectively.3839

Mycophenolate mofetil (MMF) is a purine antagonist which in combination with cyclosporine has been effective in the prevention of GVHD in preclini-cal (canine) models40 and in clinical trials following HLA-matched nonmyeloablative transplantation.41 Recently, the combination of MMF and tacrolimus was shown to have similar GVHD protective effects as cyclosporine and methotrexate following HLA-matched myeloablative stem cell transplantation.42 Mucositis was reportedly less frequent than with methotrexate-containing regimens and delayed engraftment was obviated.

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