J. D. J. Bakker

Leiden University, Leyden, South Holland, Netherlands

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Publications (2)3.57 Total impact

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    ABSTRACT: The transplant policy for unrelated donor (UD) BMT at Leiden Paediatrics' SCT-Centre consisted of the use of (1) fully HLA-matched donors or, if not available, HLA-class I matched and/or cytotoxic T-lymphocyte precursor (CTLp)-negative donors and (2) protective isolation of the recipient and antimicrobial suppression of his/her gut microflora to prevent infections and acute GVHD. Engraftment, GVHD, relapse in the case of malignancy and survival were studied retrospectively in 126 evaluable children, transplanted between 1988 and 2005. In addition to the effect of HLA-matching, that of other transplant-relevant variables on the outcome was also studied. Actuarial OS was 65% and the EFS was 59%, 13% graft failures occurred and 7.5% > or =grade II acute GVHD. HLA-class II mismatches combined with HLA-class I matches resulted in a superior OS of 92%, as did a negative vs positive CTLp test, that is, 65 vs 33%. Analysis of other variables showed a poorer OS in patients > or =10 yrs vs <10 yrs, that is, 54 vs 73%, and in male recipients of a female donor graft, that is, 53 vs 69% for other combinations. UD-BMT can be optimized by permitting HLA-class I-matched and/or CTLp-negative donors, and probably by choosing male donors for male recipients.
    No preview · Article · Jun 2009 · Bone marrow transplantation
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    ABSTRACT: Chronic graft-versus-host disease is sometimes a severe, disabling and long-lasting complication of allogeneic hematopoietic stem cell transplantation. Its frequency lies between 10 and 40% of pediatric graft recipients, depending on a number of risk factors. Such factors are the type, i.e. HLA-identical related or not, gender and age of the stem cell transplant donor, original diagnosis of the patient and, most importantly, the occurrence or not of a prior acute graft-verus-host disease. Chronic graft-versus-host disease manifests itself as a collagen vascular autoimmune disease. Its treatment consists of immuno-modulatory and antiinfections drugs, in addition to supportive care and psycho-social support. Medical treatment demands a tailor-made approach and careful and prolonged surveillance.
    Full-text · Article · Dec 2002 · Reports of Practical Oncology and Radiotherapy