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Query: UMLS:C0018133 (graft-versus-host disease)
 18,032 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have presented an immunocompetent patient who, after paternal lymphocyte immunization, developed a GVH-like skin reaction; she recovered spontaneously. This complication is rarely seen. This was the only case observed in our series of over 70 patients immunized. A similar phenomenon was not reported in a larger series by Carp and colleagues (1). However, the case deserves special attention because this reaction can be life-threatening. Therefore, we suggest that paternal lymphocyte immunization should be recommended only for those patients who have undergone a thorough work-up and in whom all causes, other than immunological, for recurrent abortion have been excluded. Even then, this treatment should be given with utmost caution. In view of the above described complication, we believe that more data are still required to justify offering such a treatment modality on a routine basis.
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PMID:Cutaneous graft-versus-host-like reaction after paternal lymphocyte immunization for prevention of recurrent abortion. 142 69

4 patients (3 female, 1 male) bone marrow transplanted for severe aplastic anemia (3 allogeneic, 1 syngeneic) became pregnant or parented children 19, 37, 81, and 34, 52 months, respectively, after BMT. Conditioning regimen consisted of 200 mg/kg Cyclophosphamide. Donor buffy coat cells were used for rejection prophylaxis, and methotrexate was used as GVHD prophylaxis. 1 female patient developed a mild chronic graft versus host disease with vaginal sclerosis which made a cesarean section necessary. 3 out of 5 pregnancies were uneventful. 1 patient had mumps in the 14th week, another patient had a late abortion in the 25th week of unknown cause. A high incidence of offspring complications was noticed including 1) persistence of fetal circulation syndrome, 2) erythroblastosis fetalis, and 3) prolonged newborn-icterus. These observations confirm previous reports on resumed fertility after BMT for SAA. A relation between the unexpected high incidence of pre-, peri-, and postpartal complications and the BMT procedure can neither be proved nor excluded.
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PMID:[Pregnancy and fetal complications after bone marrow transplantation]. 194 50

The central issues of the immunology of the placenta are poorly defined. As an allograft its success almost certainly depends on the absence of transplantation antigens from syncytiotrophoblast. The placenta is an imperfect immune barrier between mother and fetus. Rhesus isoimmunization is one well-known consequence but maternal graft-versus-host disease is another, although much rarer. The placenta performs an important function by transferring maternal IgG to the fetus and filters out potentially harmful cytotoxic antibodies. However, autoantibodies may, in rare circumstances, cause passively acquired fetal autoimmune disease. Direct maternal immune attack on the placenta is not a clear pathological entity but may occur with placental villitis and pemphigoid gestationis; and may contribute to recurrent abortion of unknown aetiology or to pre-eclampsia.
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PMID:Immunology of the placenta. 353 55

Over the past decade, many studies have suggested that allogeneic blood transfusions (ABT) may adversely affect a recipient. The ABT-associated deleterious effects include the development of transfusion reactions, graft-versus-host disease, alloimmunization, and immunomodulation. While the ABT-associated immunosuppressive effects might be beneficial for recipients of kidney allografts, in reducing the relapse rate in patients with Crohn's disease, and in ameliorating the rate of abortion in women with recurrent spontaneous abortions; evidence is accumulating that the immunosuppression associated to perioperative ABT might adversely affect overall prognosis in patients with a malignancy undergoing curative cancer surgery. In addition, the ABT-associated immunomodulation has been reported to be associated with an increased risk for postoperative bacterial infections. Data from both inbred and outbred experimental animal models indicate that ABT promote tumor growth. Evidence is available that this ABT-promoting tumor growth effect can be adoptively transferred to naive animals, using splenic immunocytes. Furthermore, data from the experimental animal models indicate that the ABT effect on the growth of tumors is due to the presence of the donor leukocytes in the transfused allogeneic blood, and that this deleterious effect can be ameliorated by the pre-storage leukodepletion of the allogeneic blood. Importantly, recent evidence suggests that post-storage leukodepletion is inefficacious in preventing the ABT-associated tumor growth promotion effect. While results from studies in experimental animals cannot necessarily be extrapolated to the clinical situation, these studies suggest that ABT promote tumor growth and that pre-storage leukodepletion ameliorates this effect.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The tumor growth-promoting effect of allogeneic blood transfusions. 771 92

A considerable amount of information has accumulated over the past decade indicating that the transfusion of allogeneic blood products may be associated with adverse effects to the recipient. These include the development of transfusion reactions, TA-GVHD, HLA-alloimmunization, and immunomodulatory effects. The latter might be beneficial for recipients of kidney allografts, in reducing the relapse rate in patients with Crohn's disease, and in ameliorating the rate of recurrence of spontaneous abortion in affected patients; however, the immunosuppressive effects associated with perioperative ABT might adversely affect overall prognosis in patients with a malignancy who undergo curative cancer surgery. In addition, ABT has been shown to be associated with an increased risk for postoperative bacterial infections. The ABT-induced immunomodulatory effects appear to be mediated immunologically by transfused allogeneic passenger leukocytes. The 3 log10 leukocyte reduction of cellular blood products, provided by the currently available commercial leukocyte filters, has been shown to minimize the occurrence of some of the ABT-associated deleterious effects; however, the actual clinical efficacy of leukodepletion has not yet been established, because the available data are largely from retrospective or uncontrolled clinical studies. Properly designed prospective clinical trials are essential to establish optimal conditions for the preparation of blood components destined for clinical use.
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PMID:Immunosuppressive effects of allogeneic blood transfusions: implications for the patient with a malignancy. 773 42

Recurrent spontaneous abortion is being treated with alloimmunotherapy which consists of the inoculation of allogeneic mononuclear cells. However the mechanisms explaining the benefits of this therapy are not clear yet. Taking the immunotrophic hypothesis as the paradigm of the field of reproductive immunology, hereby we present a hypothesis to propose a role for the immune system in reproduction and at the same time to explain how alloimmunotherapy may work. We base our view on several facts: first, immunodeficient mice reproduce--albeit their progeny may not be as robust and numerous as that from normal individuals. Second, maternal lymphocytes cross the placenta and may induce graft versus host disease. Third, graft versus host disease in newborn F1 mice inoculated with paternal lymphocytes can be prevented by inoculation of the mother with the same paternal lymphocytes before and during pregnancy. We propose that: 1) the immune system by itself is not necessary for placental reproduction; 2) the immune system plays its major role in reproduction by counteracting the allogeneic response generated against the fetus; 3) recurrent spontaneous abortion represents a type of graft versus host disease induced by maternal cells infiltrating the fetus; and 4) alloimmunotherapy induces an antiidiotypic response necessary to counteract the graft versus host reaction in the fetus.
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PMID:Is the immune system necessary for placental reproduction? A hypothesis on the mechanisms of alloimmunotherapy in recurrent spontaneous abortion. 805 76

A considerable literature has accumulated over the past decade indicating that leukocytes present in allogeneic cellular blood components, intended for transfusion, are associated with adverse effects to the recipient. These include the development of febrile transfusion reactions, graft-versus-host disease, alloimmunization to leukocyte antigens, and the immunomodulatory effects that might influence the prognosis of patients with a malignancy. Moreover, it has become evident that such leukocytes may be the vector of infectious agents such as CMV, HTLV-I/II, and EBV as well as other viruses. An interesting development that has occurred coincidentally in transfusion medicine is that agencies responsible for the provision of blood products are being designated manufacturers of biologicals. The trend among manufacturers of biologicals is to try to produce pure products to provide for the specific therapeutic need of patients. Thus, with the realization that allogeneic leukocytes and their products may have adverse biologic activities, there is increasing pressure from various sources for the reduction of the leukocyte content in allogeneic blood components to minimize the occurrence of their adverse effects. Although the threshold leukocyte number below which these effects might no longer occur is still to be determined, a 2 to 3 log10 leukocyte reduction, provided by the currently available commercial leukocyte filters, has been shown to reduce the frequency of many of such reactions. On the other hand, the immunosuppressive effects produced by the infusion of allogeneic leukocytes might be beneficial for some patients, ie, for the maintenance of kidney allografts, in possibly reducing the relapse rate in patients with inflammatory bowel diseases, and in ameliorating recurrent spontaneous abortion. Moreover, therapeutic granulocyte transfusions may be of benefit in certain well-defined categories of patients infected with bacteria, yeast, and/or fungi. These include neonates with bacterial sepsis associated with bone marrow failure as well as severely neutropenic leukemic patients with an infection unresponsive to appropriate and specific antibiotic therapy. Many of the results obtained with the use of leukocyte depletion filters are tantalizing, but the actual clinical benefit of leukodepletion has not been established in most instances, because much of the available data are retrospective or from uncontrolled clinical trials. Moreover, issues of cost-effectiveness and quality control have not been considered adequately. Properly designed prospective clinical trials are essential to provide data with which to answer such questions and also to help define the optimal conditions required for the preparation of blood components ultimately destined for clinical use. Only with the availability of such data can sound decisions be made about the clinical value of leukodepletion.
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PMID:Biologic effects of leukocytes present in transfused cellular blood products. 808 Sep 81

In recent years, dramatic progress has been made through research using dead human fetal tissue. Cellular transplantation is an attractive alternative to organ grafting when only a discrete function of the organ is impaired. Early fetal donor cells have an advantage because they engraft readily and do not cause graft-versus-host disease. Similarly, the fetus is an ideal recipient of allogenic fetal cells as it is incapable of rejecting them early in gestation. Recent research advances have led to its use in endocrine, neurologic and immune system disorders as well as in hematologic and hepatic deficiencies. Concurrently, this research has led to controversy over the ethics of using human fetal tissue, particularly tissue from induced abortions. Although legalized abortion remains a hotly debated controversial issue in the USA and some other countries, a consensus has been forming, in the scientific community, on the ethical use of fetal tissue in research and clinical transplantation. This review presents the theoretical background and recent research and clinical advances in fetal tissue transplantation, in the light of the current debate on its ethical and moral implications.
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PMID:The use of fetal tissue for therapeutic applications. 810 81

Based on our experience in the field of fetal liver transplantation (FLT) that we have developed since 1976, we initiated, in 1988, in utero FLT into human fetuses, taking advantage of the immunologic tolerance in young fetuses. The transplants have involved fetuses suffering from various diseases at 12-28 weeks postfertilization, with 2 of the 6 cases eventually resulting in abortion. With the 4 other fetuses, a favorable outcome was observed. Three children are more than 4 years old, and they are alive and well, with evidence of engraftment, reconstitution of immunity, and partial correction of beta-thalassemia. In the fourth case, the fetus is alive and well and birth is expected soon. In utero transplantation of stem cells is a therapy with remarkable advantages: (a) tolerance induction due to immune immaturity of the host, (b) lack of graft-versus-host disease (GVHD) due to immaturity of the donor, (c) ideal isolation of the fetus in the maternal uterus, and (d) optimal environment for donor fetal cell development in the vicinity of host fetal cells and growth factors.
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PMID:In utero transplantation of fetal liver stem cells into human fetuses. 872

Although the safety of allogeneic blood transfusion has increased dramatically in recent decades, some risks remain. Contamination with infectious agents-including viruses, bacteria, spirochetes, and parasites-is still possible, although recent advances in blood screening and testing have decreased the risk. The principal noninfectious complication of blood transfusion is immunomodulation. Clinical manifestations of transfusion-related immunomodulatory activity include hemolytic and allergic reactions, graft-versus-host disease, the possible decreased survival in patients with cancer, as well as increased susceptibility to postoperative infection, activation of latent infection, improvement in organ allograft survival, decreased frequency of spontaneous abortion, and moderation of immune inflammatory disease. The cause of transfusion-related immunosuppression is not yet known, but possible contributing factors are the development of a suppressor cell network, formation of anti-idiotype antibodies, clonal deletion, macrophage paralysis, up-regulation of cells with latent infections, cytokine infusion, and contamination by infectious and noninfectious agents.
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PMID:New insights into the management of anemia in the surgical patient. 883 25


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