title: Allogeneic transplantation in the UK: an aggregation of marginal gains?
abstract: 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.
authors.affiliation: Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Kirsty J
authors.initials: KJ
authors.lastname: Thomson
authors.forename: Karl S
authors.initials: KS
authors.lastname: Peggs
mesh_terms: D046528:Chimerism; D019788:Fluorodeoxyglucose F18; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006650:Histocompatibility Testing; D006801:Humans; D007239:Infections / Q000209:etiology; D018365:Neoplasm, Residual; D014019:Tissue Donors; D014055:Tomography, Emission-Computed; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: PET; chimerism; human leucocyte antigen matching; transplantation; viral infection