Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: EC:2.1.1.69 (BMT)
2,655 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Disseminated fungal infection not infrequently complicates the course of allogeneic bone marrow transplantation (allo BMT) in severely immunocompromised patients, and the prognosis of BMT patients who develop systemic fungal infection is very poor. We describe a patient who developed disseminated Candida albicans infection with liver abscess after the first allo BMT for acute myelogenous leukemia (FAB M2). The infection was successfully eradicated by the administration of miconazole and amphotericin B. However, 1 year after the first allo BMT, the patient suffered a relapse of acute myelogenous leukemia with fungal liver abscess. A second allo BMT, accelerating granulocyte recovery by recombinant human granulocyte colony-stimulating factor (rhG-CSF), was successfully performed and the fungal liver abscess resolved with a combination therapy of fluconazole and amphotericin B. The patient is alive and free of both leukemia and fungal disease more than 37 months after the first allo BMT and 25 months after the second allo BMT.
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PMID:Successful second allogeneic bone marrow transplantation in a relapsed acute myeloid leukemia patient with fungal liver abscess. 138 22

Invasive aspergillosis in now the second most common mycosis encountered in patients with cancer, particularly those with haematological malignancies. The present review discusses strategies for the chemoprophylaxis of invasive pulmonary aspergillosis. Recommendations for chemoprophylaxis are currently based on the particular fungal pathogens seen in individual centres and the resources available. In many units, only BMT recipients are nursed in protected environments and the majority of patients at risk of invasive mycosis, i.e. patients undergoing remission induction or consolidation therapy, are nursed on open wards. The studies so far reported have included relatively small numbers of patients and provide insufficient data for definitive recommendations. The measures used at present should be considered as ad hoc approaches for use in units in which spore-free air for profoundly neutropenic patients is lacking. Nebulized amphotericin B allows deposition of a chemical barrier throughout the airways. Intravenous low dose amphotericin B would be protective when invasion occurs and is clearly the chemoprophylaxis of choice in patients with an established diagnosis of previous invasive aspergillosis at any site. The role of surgery in removing a focus of infection before further chemotherapy, should not be overlooked. The potential role of cytokines in accelerating host defence recovery may in future also prove to be important in controlling invasive fungal infection.
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PMID:Chemoprophylaxis of invasive pulmonary aspergillosis. 808 65

Alternariosis, a fungal infection resembling aspergillosis, has been described in immunocompromized and immunocompetent hosts. We report a case of cutaneous alternariosis that occurred during neutropenia in an allogeneic BMT patient receiving antifungal prophylaxis with fluconazole. Therapy required surgical excision and iv amphotericin B. Awareness of this entity may help in early diagnosis and successful therapy.
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PMID:Cutaneous alternariosis and regional lymphadenitis during allogeneic BMT. 833 31

In August 1988 we began a program in which multiple myeloma patients achieving < or = 10% marrow plasma cells and > or = 50% reduction in paraprotein levels after the VAD (vincristine, doxorubicin, dexamethasone) regimen underwent bone marrow harvest, ex vivo marrow purging with 4-hydroperoxycyclophosphamide (4-HC) and marrow cryopreservation. Conditioning with a regimen of high-dose busulfan (total dose 16 mg/kg), cyclophosphamide (120 mg/kg) and melphalan (90 mg/m2) (BU + CY + MEL) followed by autologous BMT was then carried out. Seventeen of the 24 patients who received VAD (71%, 95% confidence interval [CI] 49 to 87%) were eligible for bone marrow harvest. One patient was not harvested because of non-medical reasons; two patients who underwent marrow harvest had gross plasmacytosis present in biopsies performed intraoperatively and did not undergo BMT. Fourteen patients (58%, 95% CI 37 to 78%) received BU + CY + MEL and 4-HC-purged autologous BMT. The median time to recovery of 0.5 x 10(9)/l neutrophils was 19 days (range 14 to 26) while the last platelet transfusion was given on a median of day 32 (range 10 to 46) post-BMT in the evaluable patients. The major non-hematologic toxicity was hepatic; two patients in complete remission died of hepatic veno-occlusive disease. Another patient succumbed to fungal infection despite neutrophil recovery. The remaining 11 patients achieved responses (complete in six and partial in five) associated with a normal performance status.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of multiple myeloma with intensive chemotherapy followed by autologous BMT using marrow purged with 4-hydroperoxycyclophosphamide. 843 63

The benefits of fungal prophylaxis with fluconazole in BMT patients appear to outweigh the risks of a possible increase in colonization and infection by C. krusei or T. glabrata. Disseminated fungal infections caused by C. tropicalis and C. albicans have a 38.8% mortality rate, and these infections may be prevented by the prophylactic use of fluconazole. C. krusei and T. glabrata infections generally do not contribute to increased mortality, and most patients infected by these organisms recover after appropriate antifungal therapy. The use of amphotericin B as prophylaxis may have some efficacy. One retrospective study found low-dose amphotericin B therapy to be effective in preventing Candida infections, but results from a placebo-controlled, randomized prospective trial with 0.1 mg/kg/d failed to support this claim. Low-dose amphotericin B prophylaxis (0.1-0.25 mg/kg/d) shows promise against aspergillosis, an opportunistic infection associated with high morbidity and mortality. The literature suggests the possible value of using oral or intravenous fluconazole 200-400 mg/d or intravenous amphotericin B 0.1-0.25 mg/kg/d as antifungal prophylaxis in patients after autologous or allogeneic BMT. Many questions remain unanswered, however. These studies described the potential decrease in morbidity and mortality of BMT patients with the use of either fluconazole or amphotericin B, but it is not known whether all patients after BMT or only those at high risk of fungal infection may benefit from prophylaxis. Optimal dosing of either antifungal agent has not been defined in the studies. Clinicians should be aware of the possible increase in colonization by less pathogenic fungal species, such as C. krusel and T. glabrata, when prescribing fluconazole prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Antifungal prophylaxis in bone marrow transplant. 854 42

The successful use of granulocyte transfusions in a patient undergoing volunteer unrelated donor BMT for very severe aplastic anemia complicated by presumed fungal infection is described. Granulocytes were obtained by leukapheresis of normal volunteer donors stimulated by granulocyte colony-stimulating factor. The yields of granulocytes obtained by this method were sufficient to produce sustained neutrophil increments in the recipient throughout the transplant course. In vitro studies indicated that granulocytes were functionally normal, a finding which was supported clinically by the rapid resolution of infection, even in the setting of immunosuppression post-transplantation. This demonstrated the potential value of granulocyte transfusions in high-risk BMT.
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PMID:Multiple granulocyte transfusions facilitating successful unrelated bone marrow transplantation in a patient with very severe aplastic anemia complicated by suspected fungal infection. 854 74

The number of patients undergoing BMT is rising steadily. The increase is due to a broadening of the indications for transplantation and an increase in the donor pool. There has been a progressive improvement in outcome particularly due to a fall in transplant-related mortality. Methotrexate and cyclosporin are the mainstay of graft versus host disease (GVHD) prophylaxis, but acute GVHD remains a major problem in the unrelated donor recipient. Infections remain an important cause of death and emphasise the crucial role of antimicrobial prophylaxis; death from Gram-negative sepsis has been significantly reduced by the use of prophylactic antibiotics. Fungal infections carry a high mortality, especially in allogenic transplant recipients. Fluconazole is used to protect patients in the neutropenic period and beyond in higher risk individuals. Viral infections, which may occur late, are emerging as a significant cause of morbidity and mortality in the allogeneic, particularly unrelated transplantation setting. A long term susceptibility to encapsulated bacteria suggests delayed immune reconstitution; revaccination policies are standard in most units. The longer term effects of transplantation are increasingly important with improving survival and include chronic GVHD, endocrine, cardiorespiratory and other systemic abnormalities. The increased risk of secondary malignancies is also of concern.
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PMID:Bone marrow transplantation: current situation, complications and prevention. 860 39

The recovery of gamma delta T lymphocytes was studied in 31 recipients of T cell-depleted allogeneic bone marrow (BMT) to determine if the dynamics of reconstitution could be related to graft-versus-host disease (GVHD) or other complications of marrow transplantation. Two distinct patterns of regeneration were apparent. In 12 patients, there was a progressive rise in both the percentage and the absolute number of peripheral blood gamma delta T cells over the first year post-transplantation, but these increases never breached levels found in 14 healthy donors. Each of the 19 remaining patients had abnormally high proportions and numbers of gamma delta T cells on at least two occasions following transplantation. The clinical factor that best explained these observations was the frequency of intercurrent infections. Of 19 patients with abnormally increased percentages and numbers of gamma delta T lymphocytes, 18 had one or more episodes of confirmed viral or fungal infection, contrasted with only two of 12 in the comparison group (P < 0.001). There was no significant association of gamma delta T cell recovery patterns with the presence of GVHD (P = 0.33). We conclude that the recovery of gamma delta T lymphocytes after marrow transplantation may vary. Supranormal levels of this T cell subset are associated with infection and may contribute significantly to cellular immune defenses against fungal or viral disease.
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PMID:Gamma delta T lymphocyte regeneration after T lymphocyte-depleted bone marrow transplantation from mismatched family members or matched unrelated donors. 864 Jan 74

In a retrospective analysis, 79 allogeneic bone marrow recipients treated with AmBisome prophylactically or because of proven or suspected invasive fungal infection (IFI) were evaluated in 92 episodes. The median duration of treatment was 14 (range 1-112) days. The mean maximum dose given was 1.64 +/- 0.8 mg kg-1 day-1 and the mean total dose was 1.29 +/- 2.28 g. The overall incidence of reported adverse events was 194, of which none had a serious outcome. In six cases, the drug was withdrawn as a result of toxic or allergic reactions: dyspnoea and flush (3), urticaria (1), cholecystitis (1) and disorientation (one case, probably not related to AmBisome). No anaphylactoid reactions were seen. Laboratory findings, including low serum potassium (48% of the episodes), increased serum creatinine (38%) and increased serum sodium levels (7%), caused no major clinical problems. Thirteen cases of verified IFI were evaluated regarding the efficacy of AmBisome. Survival or cure of the mycotic infection occurred in 5/13 patients (38%). Two patients were treated with AmBisome (3.6 and 3.3 mg kg-1 day-1) because of verified IFI before BMT. One died of IFI. The other died of venoocclusive disease of the liver (VOD) without histological evidence of active IFI. We found a significant (P < 0.05) reduction in autopsy-proven IFI, 12/199 (6%) compared to the period when only conventional doses of amphotericin B were used, 26/227 (11%).
Mycoses
PMID:Safety and efficacy of liposomal amphotericin B in allogeneic bone marrow transplant recipients. 890 28

A case of Fusarium sp. infection of the brain in a 6-year-old child who underwent allogeneic BMT is reported. As far as the authors know, this is the first report of Fusarium sp. encephalitis in a BMT patient. Fusarium sp. infection is a rare but emerging fungal pathogen after BMT and, because of several similarities, it is often mistaken for other mold infections, such as Aspergillus sp. The importance of early identification of this fungus as a cause of disseminated fungal infection in BMT patients, and some new modalities of Fusarium sp disseminated infection treatment are discussed here.
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PMID:Disseminated Fusarium sp. infection affecting the brain of a child after bone marrow transplantation. 893 59


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