Prevention Of Hematopoietic Stem Cell Rejection

It is necessary to abolish host defenses prior to transplantation to avoid immune-mediated graft rejection caused by alloreactive cytotoxic host T lymphocytes in the major histocompatibility complex (MHC)-identical setting16 22 and by alloreactive cytotoxic host T lymphocytes, host natural killer (NK) cells, and HLA-spe-cific antibodies in the MHC-mismatched setting.2324 The risks of graft rejection increase in cases of HLA disparities or host sensitization to major and minor histo-compatibility antigens via administration of multiple blood products.25 26 Both the conditioning regimen and the donor T lymphocytes are instrumental in the destruction of the host immune system. The latter implies that T-cell depletion of the graft as a method to prevent graft-versus-host disease (GvHD) may also have deleterious effects on engraftment.27

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