Allogeneic transplantation in the UK: an aggregation of marginal gains?
Article first published online: 27 JUL 2013
© 2013 John Wiley & Sons Ltd
British Journal of Haematology
Volume 163, Issue 2, pages 149–159, October 2013
How to Cite
Thomson, K. J. and Peggs, K. S. (2013), Allogeneic transplantation in the UK: an aggregation of marginal gains?. British Journal of Haematology, 163: 149–159. doi: 10.1111/bjh.12497
- Issue published online: 3 OCT 2013
- Article first published online: 27 JUL 2013
- human leucocyte antigen matching;
- viral infection;
A number of advances in clinical practice that are considered routine in modern allogeneic transplant programmes lack definitive supporting evidence, partly because they may offer modest incremental benefits that are difficult to demonstrate in a statistically robust manner given the relatively small cohorts of patients who undergo such procedures. Nevertheless, these marginal gains probably contribute therapeutically meaningful overall benefit, particularly when aggregated. We review the evidence for a number of these practices in terms of impact on transplant outcomes, with particular reference to the setting of T cell depletion as widely practiced in the United Kingdom, including high resolution tissue typing, surveillance for and therapy of infectious complications, chimerism-directed immune modulation and more sensitive monitoring for residual or progressive disease.