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Title: Novel strategies for managing graft-versus-host disease
Author: Dignan, F. L.
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2012
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Graft-versus-host disease (GvHD) is a major barrier to the successful outcome of allogeneic haematopoietic stem cell transplantation. This thesis investigates four novel strategies for managing GvHD: the role of extracorporeal photopheresis (ECP), the use of economic data to allow for funding of new treatments, the impact of a new dedicated GvHD clinic and the writing of national guidelines. The main hypothesis is that fortnightly ECP would improve signs and symptoms of chronic GvHD. A single centre retrospective analysis of 82 patients showed that this ECP schedule was effective with 94% of patients who completed 6 months of treatment achieving a complete or partial response. The information derived from this study was subsequently used to design a study to test this hypothesis in a prospective cohort of patients. 70% of patients who completed 6 months of ECP had a complete or partial response. Analysis of quality of life in a subset of patients showed a significant improvement in chronic GvHD symptom score (22 v 36, p=0.012) and dermatology quality of life index (3.4 v 6.9, p=0.009). A second hypothesis is that patients with GvHD have a higher readmission rate and economic burden than patients without GvHD. A retrospective review of 187 consecutive patients was undertaken which showed that the overall readmission rate was higher in patients with GvHD (86% (101/118) v 59% (41/69), p<0.001). The mean cost of readmission was higher in GvHD patients (£28860) than in non-GvHD patients (£13405; p=0.002) and in patients with grade III/IV GvHD (£40012) compared to those patients with grade I /II GvHD (£24560; p=0.038). This information was used to obtain funding for on-site ECP for acute GvHD. In addition, an exploratory evaluation of a new dedicated GvHD clinic is reported demonstrating the impact on referral patterns, quality of life and morbidity and mortality and the process of writing three national clinical practice guidelines is described.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available