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)

In attempt to identify major clinical features of paranasal sinusitis following allogeneic BMT, we reviewed 44 consecutive cases diagnosed at the Hammersmith Hospital between August 1993 and December 1995. All patients had symptoms and signs characteristic of sinusitis. Plain radiographs and/or CT scans revealed fluid levels in 86.4% of patients, opacification in 9.1%, and marked mucosal thickening in 4.5%. Two-thirds of patients were diagnosed within 120 days of BMT. The WBC was less than 1 x 10(9)/1 in 16.3% of patients, the neutrophil count was less than 0.5 x 10(9)/1 in 18.6%, and serum immunoglobulins were depressed (< 6.7 g/l) in 40.6%. Grade III-IV acute GVHD was present in 25.6% of patients and grade I-II in 66.7%; 68.6% developed chronic GVHD. There were 70.5% of patients receiving corticosteroids. Specific pathogens could not be identified in most cases. Pneumonia was present in 10 patients, seven of whom had Aspergillus species identified by bronchoalveolar lavage. Parainfluenza virus was isolated in three patients and Pseudomonas aeruginosa in two. Although all patients received antimicrobial therapy, 70.5% developed chronic sinusitis. Fatal complications did not occur. In 94 consecutive patients receiving allografts for CML during the period of study, WBC and neutrophil counts were lower 3 months post-BMT in patients who developed sinusitis (P < 0.02). Patients receiving higher doses of total body irradiation (13.2 and 14.4 Gy) had a greater probability of developing sinusitis (P = 0.023). Sinusitis occurred in only one of 37 patients receiving autologous transplants in the same period. Sinusitis is common following allogeneic BMT. Leukopenia is often present, but microbiological diagnosis is difficult, and progression to chronic sinusitis common.
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PMID:Paranasal sinusitis following allogeneic bone marrow transplant. 901 32

We evaluated eight cases of pulmonary mycosis in immuno compromised hosts. The underlying diseases were lung cancer with chemotherapy in one case, post bone marrow transplantation (post BMT) in two cases, acquired immunodeficiency syndrome (AIDS) in one case and bronchial asthma with massive steroid therapy in four cases. The causative fungi were Candida sp. in three cases, Aspergillus sp. in four cases, Tricosporon sp. in one case. Prognosis was guarded despite antifungal treatment. Five cases deteriorated and died of fungal infection. In five cases, who died of deterioration, 31.6 days was required from appearance of abnormal infiltration in the chest X-ray to determination of the causative fungi (including two cases who were diagnosed by autopsy) on the average. In three successfully treated cases, the average duration from the appearance of abnormal infiltration in the chest X-ray for the determination of the causative fungi was 8.3 days. On the contrary, the average duration between the appearance of abnormal infiltration in the chest X-ray and the initiation of antifungal treatment was 2.6 days who died of deterioration and 8.3 days who survived. We conclude that early identification of causative fungi and not quick institution of antifungal treatment was mandatory in the treatment of opportunistic fungal pneumonia.
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PMID:[Clinical features of eight cases of opportunistic fungal pneumonias]. 913 30

We report a patient who developed bronchiolitis obliterans organizing pneumonia (BOOP) after syngeneic BMT for ALL. The patient complained of persistent low-grade fever and non-productive cough after engraftment. Chest CT scan showed patchy infiltration bilaterally in the lower lung fields. Antibiotics were ineffective. Cultures, serological studies and polymerase chain reaction detected no infectious pathogens. We finally made a diagnosis of BOOP by thoracoscopical lung biopsy. The lung lesion disappeared in a month with corticosteroid therapy. While BOOP following allogeneic BMT has been reported, this is the first report after syngeneic transplantation.
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PMID:Bronchiolitis obliterans organizing pneumonia after syngeneic bone marrow transplantation for acute lymphoblastic leukemia. 920 21

Fiberoptic bronchoscopy (FOB) has been reported to have a high diagnostic yield and to be safe in BMT patients with pulmonary infiltrates. At our institution, BMT patients with respiratory symptoms and/or pulmonary infiltrates had a thoracic CT and bronchoalveolar lavage (BAL). Transbronchial biopsy (TBBx) was considered if the platelet count could be raised to >30 x 10(9)/l. From March 1993 to August 1995, 52 patients had 68 FOBs (42 BAL + TBBx, 26 BAL only) for 60 episodes of clinical pneumonia. Patients' characteristics were: 38 males, mean age 42 years, and 39 allogeneic BMTs. Of the 68 FOBs, 47 were performed to evaluate diffuse infiltrates, 10 were done on mechanically ventilated patients, and 50 of the FOBs were preceded by a platelet transfusion. Thirty-one percent of FOBs (21 FOBs, 19 patients) were diagnostic. Twenty-four percent of FOBs (11 diagnostic FOBs, six nondiagnostic FOBs) changed therapy. Ten complications (15%) occurred in 10 FOBs (five acute respiratory failure, three pneumothoraces, one nose bleed, one death). Hospital and 6-month survival based on episodes of clinical pneumonia were 47 and 32%, respectively. Patients who had a diagnostic FOB or a FOB that changed treatment did not have better hospital or 6-month survival compared to patients who had FOBs that were nondiagnostic or did not change treatment. FOB in our BMT patient population, had a low diagnostic yield (31%), infrequently changed treatment (24%), a significant complication rate (15%) and was not associated with improved patient survival. The role of routine diagnostic FOB in BMT patients with pulmonary infiltrates and/or respiratory symptoms should be reevaluated.
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PMID:Utility of fiberoptic bronchoscopy in bone marrow transplant patients. 938 32

A 52-year-old Japanese woman suffering from AML (FAB classification M4) in her first remission received an autologous peripheral blood stem cell transplant (APBSCT). She was seropositive for CMV prior to APBSCT. Her post-APBSCT course was complicated with CMV-associated disease and hemophagocytic syndrome. Finally, CMV interstitial pneumonia developed and death ensued. Even after APBSCT, there can be a short period of immune deficiency resembling that occurring following allogeneic or autologous BMT. CMV infection must be considered in the differential diagnosis in cases of unexplained fever or pneumonia following APBSCT.
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PMID:Fatal cytomegalovirus interstitial pneumonia following autologous peripheral blood stem cell transplantation. Fukuoka Bone Marrow Transplantation Group. 948 56

A 37-year-old female highly alloimmunized by multiple transfusions received a sex matched HLA-identical unrelated bone marrow transplant for hypoplastic MDS-RA with moderate myelofibrosis. Conditioning consisted of total body irradiation, cyclophosphamide and ATG, GVHD prophylaxis consisted of CsA, MTX and prednisolone. The CD34+ stem cell content of the first graft was relatively low due to an inadequate harvest. The patient appeared not to have engrafted by day 23 post-BMT. She therefore received a second sex mismatched HLA-identical unrelated bone marrow graft on day 25 after two days of 3.5 mg/kg methylprednisolone from a different donor. Over the ensuing days, the first marrow showed slow engraftment followed by engraftment of the second graft. The first graft was then rejected, as monitored by peripheral blood studies of chimerism. No signs of acute GVHD were observed. Despite successful trilineage engraftment and complete second donor chimerism, the patient died from disseminated toxoplasmosis encephalitis and pneumonia on day +104.
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PMID:Second unrelated bone marrow transplantation without additional conditioning therapy after engraftment failure. 948 60

Bacterial and fungal infections in pediatric BMT recipients are major causes of morbidity and mortality, although less than those in the adult BMT population. Early in the post-BMT period, when patients are neutropenic, the predominant pathogens are Gram-negative bacteria, mainly E. coli, K. pneumoniae and P. aeruginosa; Gram-positive bacteria, mainly coagulase-negative staphylococcus, S. viridans and E. faecalis; and fungi, mainly Candida spp. and Aspergillus spp. The emerging resistance of a variety of pathogens is of major concern and limits the use of prophylactic antibiotics. Mortality from invasive fungal infections is much greater than that caused by bacterial pathogens. Many centers are currently using prophylactic fluconazole, which may lead to emergence of infections with C. krusei and T. glabrata. Patients with GvHD are at continuous risk from bacterial and fungal pathogens. Late in the post-BMT period, S. pneumoniae may cause septicemia, meningitis, pneumonia and other respiratory infections. This may occur months or years following transplantation, with a significant mortality rate in patients with chronic GvHD. Development of rapid and reliable diagnostic methods for identifying fungal pathogens and of new therapeutic approaches for treating invasive fungal infections are now our greatest future challenges.
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PMID:Bacterial and fungal infections in children undergoing bone marrow transplantation. 963 Mar 34

Twenty allogeneic bone marrow transplant patients were treated with an additional dose of donor cells (boost dose) for graft failure (n = 7), partial graft failure (n = 11) or extensive hemolysis caused by remaining recipient cells producing anti-erythrocyte antibodies (n = 2). Donors were in 12 cases HLA-identical siblings, three mismatched related donors and five unrelated donors. Cell source was in 13 cases bone marrow and in seven peripheral blood progenitor cells. Median time from BMT to booster dose was 3.4 months (range 0.7-59.3). Median infused cell dose was 2.4 x 10(8)/kg patient (range 0.5-19.0). As GVHD prophylaxis most patients were already receiving different combinations of cyclosporine, prednisolone and methotrexate. No preparative treatment was given prior to boost in 16 patients; four received ATG. After boost, 11 patients developed acute GVHD, six grade I, four grade II and one grade III. Except for one patient, acute GVHD after boost was less, or the same grade as after BMT. Six patients developed chronic GVHD, three limited and three extensive. Five patients died within 30 days of the boost. Nine of 15 (60%) evaluable patients became transfusion independent within 30 days and three more within 60 days. Causes of death were: infections six (IP four, pneumonia two), relapse three; and GVHD three. Three out of five patients transplanted with unrelated marrow suffered from severe immunological reactions and died 2-3 months after the boost dose. Patient survival 1 and 3 years after boost was 55% and 43%, respectively. Among patients with hematological malignancies, leukemia-free survival at 3 years was 41%.
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PMID:Booster marrow or blood cells for graft failure after allogeneic bone marrow transplantation. 967 99

Allogeneic BMT is treatment of choice for acute leukaemias(AL) and chronic granulocytic leukaemia (CGL). In the period form 1989 till 1997 36 allogeneic BMT have been performed for patients with AML, ALL and CGL using HLA matched related donors in University Medical Centre Ljubljana. The procedure was successful in 80% of patients with CGL and in 50% of patients with AL. The most frequent cause of death in CGL patients was CMV pneumonitis, relapse in patients transplanted for ALL, while in patients transplanted for AML beside relapse we observed four deaths due to complications of BMT ( acute GVHD, VOD, thrombotic thrombocytopenic purpura, liver failure due to hepatitis).
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PMID:Allogeneic BMT for acute leukemia and chronic granulocytic leukemia in University Medical Centre Ljubljana-Slovenia. 991 41

The objective of this study was to define the type, the incidence and the outcome of early infectious complications (mean interval between day 1 post-BMT and the onset of fever was 9+/-3 days) occurring in granulocytopenic bone marrow transplant recipients, requiring medical intensive care unit admission. Over a five-years period, forty-one patients with microbiologically confirmed infection were enrolled, with a statistically significant higher frequency of allogeneic marrow transplant recipients (51%, p < 0.02). Infectious pneumonia occurred in 24 patients (59%), septicemia with septic shock in ten patients (24%), catheter-related infection in 5 patients (12%) and meningitis in 2 patients (5%) (p < 0.001). Twenty-six patients died (63%). Among the patients with confirmed infectious pneumonitis, which occurred most frequently in allogeneic marrow recipients (p < 0.02), 16 died (67%). This poor outcome was related to the requirement of mechanical ventilation. Eight patients (80%) with septicemia and septic shock and the two patients with meningitis died. Bacteria (Pseudomonas aeruginosa and Staphylococcal species) were the most common isolated in bronchoalveolar lavage fluid and blood cultures. We found a lower incidence of fungal or viral infections compared to previous studies. Empiric antimicrobial therapy in the cases of patients admitted in ICU may be included antibiotics anti-Pseudomonas and anti-Staphylococcus, as the ecology of hematology unit. The requirement of mechanical ventilation is the main adverse prognostic factor in transplanted patients. At ICU admission, patients with hepatic failure combined with respiratory failure represented a subgroup with a dismal prognosis.
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PMID:Early infectious complications after bone marrow transplantation requiring medical ICU admission. 992 26


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