Investigation of the late effects of allogeneic marrow transplantation for hematologic malignancies is vital for the overall quality of the database of this grant and CA 18029. The broad objective of this project is to reduce the late morbidity and mortality of allogeneic transplantation and improve the well-being of the marrow graft recipient. In project A we propose to reduce complications of transplantation by: 1) evaluating the role of intravenous immunoglobulin (IVIg) in preventing mortality and serious infection in unrelated-donor transplants, 2) testing whether a low- dose, intensive-schedule of IVIg retains efficacy in preventing graft- versus-host disease (GVHD) in adults given related-donor transplants, 3) documenting the pattern and etiology of cutaneous abnormalities after transplantation and evaluating the role of psoralen and ultraviolet A radiation (PUVA) in the treatment of refractory cutaneous acute GVHD. In project B we propose studies to reduce the morbidity and mortality of chronic GVHD by: 1) evaluating prolonged cyclosporine prophylaxis in patients at high risk to develop this complication, 2) investigating the benefit of PUVA therapy in chronic GVHD, 3) evaluating the toxicity and efficacy of rapamycin treatment, 4) conducting therapies of standard-risk and high-risk chronic GVHD. We anticipate that the orderly continuation of these investigations of the late effects of allogeneic transplantation will improve long-term disability-free survival following bone marrow transplantation from related and unrelated donors.
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