Gene/Protein Disease Symptom Drug Enzyme Compound
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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)

Bone marrow transplantation (BMT) after supralethal cytoreductive therapy in the acute leukemias, chronic myelogenous leukemia (CML), and the lymphomas may be curative in 50% to 60% of patients. The donor may be a human leukocyte antigen (HLA) matched family member (allogeneic), an identical twin (syngeneic), or the patient (autologous). In general, the outcome is best in younger patients and those transplanted early in their disease (i.e., in the first remission for acute leukemia and in the chronic phase of the disease in CML). Solutions to the major problems of allogeneic BMT, such as graft-versus-host disease and viral infections, are being actively pursued. Syngeneic and autologous BMT avoids some of the above problems, but relapses appear to be greater. Despite this problem, a significant number of cures have been accomplished. Newer methods of purging autologous marrow and newer preparative regimens promise to reduce the problem of relapses.
Cancer 1990 Feb 01
PMID:Bone marrow transplantation in hematologic malignancies. Current status. 240 2

Several of the cytokines that regulate the immune system have been tested for efficacy in the clinical setting. Of these, interleukin-2 shows particular potential for antitumor therapy when used in combination with autologous lymphokine-activated killer cells; the interferons have proved effective in the treatment of certain viral diseases and malignancies, particularly those of hematologic origin; and the colony-stimulating factors show great promise for treatment of diseases associated with bone marrow dysfunction. Heterologous monoclonal antibodies have proved effective in control of acute allograft rejection and prevention of graft versus host disease by selective elimination of cell types. Anti-idiotype antibodies are being investigated for their potential as vaccines. Many synthetic compounds possess immunomodulatory properties; one of these, inosiplex, may prove effective in enhancing immune function in patients with immune deficiencies such as AIDS.
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PMID:Therapeutic immunomodulation. 246 56

Neopterin is a pyrazino-pyrimidine compound which is biosynthesized by macrophages. Increased concentrations of neopterin have been reported in conditions causing stimulation of cellular immunity, such as viral and other infections, graft versus host disease, autoimmune diseases and different malignancies. Recently, increased urinary neopterin levels have been found in patients with acute viral hepatitis and NANB chronic hepatitis. In the present study, neopterin serum levels were measured in 23 cirrhotic patients (6 HBV related, 7 alcoholic and 10 cryptogenetic cirrhosis) and in 24 normal subjects. Mean values of serum neopterin were statistically increased in cirrhotics (3.92 +/- 3.28 ng/mL versus 1.24 +/- 0.51 ng/mL in controls, p less than 0.01). Serum neopterin values were not statistically different either in cirrhotics assessed in three different classes according to Child's classification or in cirrhotics with or without serological findings of active disease. In fact, in cirrhotic patients, serum neopterin levels did not correlate with serum aspartate and alanine aminotransferases, alkaline phosphatase, gamma-glutamyltransferase and gammaglobulins values. These data show that increased levels of serum neopterin occur in cirrhotic patients, but there is no relation between serum neopterin values and the histological activity or the clinical severity of the disease. The results are consistent with the hypothesis that activated macrophages are involved in all forms and in all stages of liver cirrhosis.
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PMID:[Blood levels of neopterin in patients with liver cirrhosis]. 248 6

Marrow transplantation (MT) is used for treatment of lymphomas and hematological malignancies. The preparative regimens (including high-dose chemoradiotherapy), as well as infections, medications, and graft-versus-host disease, result in nutritional complications. In order to determine foodservice needs, hospital personnel tabulated the foods requested and the daily number of meals ordered by 205 MT patients the final 14 days before their initial post-transplant hospital discharge. Oral and total (oral plus parenteral) caloric intakes were calculated from weighted food intake records using a computerized nutrient database. Per patient meal orders increased from 2.6 +/- 2.2 (SD) to 5.3 +/- 2.0 per day, and the mean number of items per day increased from 4.9 +/- 4.9 to 12.4 +/- 4.9, 14 days vs. 1 day prior to discharge. Beverages were the most frequently requested item, followed by bread products and cooked fruits and vegetables. Patients consumed approximately 60% of total calories from oral intake 1 day prior to discharge. The foodservice must be designed to provide a variety of foods served at frequent intervals to meet the needs of MT patients and thereby reduce dependence on parenteral nutrition.
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PMID:Food intake patterns and foodservice requirements on a marrow transplant unit. 249 93

Fourteen patients with haematological malignancies received allogeneic bone marrow transplantation from Major Histocompatility Complex compatible siblings. Five (35.7%) patients developed mild and 4 (28.6%) severe graft-versus-host disease (GVHD). There were correlations between the age of recipient (p less than 0.05), the degree of haematological support (p less than 0.1) and GVHD. The effects of the Mixed Lymphocyte Culture reactivity, donor/recipient sex match, cyclosporin A levels and the use of Total Parenteral Nutrition were not apparent. Two patients had relapses of their initial diseases. One of them did not develop any GVHD and the other only mild GVHD post bone marrow transplantation.
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PMID:Graft-versus-host disease following sibling allogeneic bone marrow transplantation--the Singapore experience. 252 15

An increasing number of diseases may be treated successfully by allogeneic bone marrow transplantation (BMT). Initially used for the treatment of immunodeficiency where a cell series or product is replaced, it has now become routine treatment for many forms of leukemia where the transplant provides the rescue after lethal marrow ablation. Recently, diseases such as thalassemia and other inherited metabolic diseases have also been treated by BMT. Formerly the problems of BMT were mainly concerned with graft versus host disease (GVHD) in HLA-matched transplants with HLA-mismatched ones not being possible as GVHD was usually fatal. Since the development of techniques for T cell removal the incidence of GVHD has greatly diminished. T cell removal has also allowed HLA haploidentical mismatched grafts to be performed successfully for immunodeficiency, but there is still a high graft rejection rate in leukemia. This also occurs to a lesser extent with HLA-matched grafts in leukemia. Furthermore, in certain forms of leukemia, particularly chronic granulocytic leukemia, the relapse rate after T cell-depleted BMT is much higher. Trials of better forms of bone marrow conditioning of the recipient are being attempted in order to prevent graft rejection and leukemia relapse. These include total lymphoid irradiation, heavier irradiation and chemotherapeutic regimens, or the use of in vivo monoclonal antibodies such as CAMPATH 1G or anti-LFA-1 (CD11a). In the future, positive selection of stem cells combined with hemopoietic growth factors may allow engraftment without graft versus host disease. This should become the method of choice for autologous transplantation for malignancy. Two monoclonal antibodies directed against the human progenitor cell antigen 1 (HPCA-1) (CD34) have been used for autologous positive stem cell selection in primates and these cells gave full hemopoietic reconstitution in the animals following lethal total body irradiation.
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PMID:Recent advances in bone marrow transplantation. 256 39

Neopterin is a pyrazino-pyrimidine compound which is biosynthesized by macrophages. Increased concentrations of neopterin have been reported in conditions causing a stimulation of cellular immunity, such as viral and other infections, graft versus host disease, autoimmune disease and different malignancies. Recently, urinary neopterin levels have been found increased in patients with acute viral hepatitis and NANB chronic hepatitis. In the present study, neopterin serum levels have been measured in 23 cirrhotic patients (6 HBV related, and 17 cryptogenetic cirrhosis, 7 of them occurring in alcoholic subjects) and in 24 normal subjects. Mean values of serum neopterin were significantly increased in cirrhotics (3.92 +/- 3.28 ng/ml versus 1.24 +/- 0.51 ng/ml in controls, p less than 0.01). Serum neopterin values were not found to be significantly different in cirrhotics assessed in three different clinical classes according to Child's classification and in cirrhotics with and without serological findings of active disease. In fact, in cirrhotic patients, serum neopterin levels did not correlate with the values of serum AST, ALT, ALP, GGT and gamma-globulin. These data show that increased levels of serum neopterin occur in cirrhotic patients, but there is no relation between serum neopterin values and the activity or the clinical severity of the disease. The results are consistent with the hypothesis that activated macrophages are involved in all stages of liver cirrhosis irrespective of its aetiology.
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PMID:Serum neopterin levels in liver cirrhosis. 263 48

While prospects for long-term survival following bone marrow transplantation (BMT) have increased, little is known about the quality of that survival. The present study was intended to document the physical and psychosocial functioning of survivors of allogeneic BMT as well as identify factors associated with variability in post-BMT functioning. Twenty-three patients who were living at home and were between 3 and 52 months post-BMT completed the Functional Living Index - Cancer and the Profile of Mood States. Results revealed that current functioning varied considerably across patients. The older a patient was at time of transplant, the poorer his current functioning was, particularly in the physical domain. Current functioning was not significantly associated with time since transplant, the diagnosis of acute or chronic graft-versus-host disease, or dose of total body irradiation given as part of BMT conditioning. Despite differences in functional status, however, only one patient indicated that he would not make the same choice again to undergo BMT. Information about the long-term functioning of BMT survivors is critical for the process of obtaining informed consent. Additionally, understanding of factors associated with variability in post-BMT functioning can increase the likelihood that patients will ultimately return to a normal, productive life.
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PMID:Physical and psychosocial functioning of adult survivors of allogeneic bone marrow transplantation. 264 90

The occurrence of graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation for leukemia is thought to decrease the probability of recurrence. To study this effect (called adoptive immunotherapy) we modified the prophylaxis of GVHD in patients with advanced hematologic neoplasms (mostly leukemia) who received bone marrow transplants. Patients under 30 years of age were randomly assigned to one of three regimens of post-transplantation immunosuppression: Group I (n = 44) received a standard course of methotrexate for 102 days after transplantation, Group II (n = 40) received an abbreviated (11-day) course of methotrexate, and Group III (n = 25) received the standard course of methotrexate plus viable buffy-coat cells from the marrow donors. All 109 patients received cyclophosphamide (60 mg per kilogram of body weight on each of two days), total-body irradiation (2.25 Gy daily for seven days), and unmodified marrow from HLA-identical sibling donors. The frequency of GVHD of Grades II through IV was 25 percent in Group I, 59 percent in Group II, and 82 percent in Group III (P = 0.0001). The incidence of chronic GVHD, however, did not differ significantly among the groups (33, 51, and 44 percent, respectively), nor did the five-year probability of recurrence of disease (38, 45, and 33 percent, respectively). However, mortality from causes other than cancer was 34 percent in Group I, 45 percent in Group II, and 64 percent in Group III (I vs. III, P = 0.024); the deaths were due primarily to infections complicating the course of GVHD. With a median follow-up of 5.1 years (range, 3.9 to 7.4), disease-free survival was 41 percent in Group I, 30 percent in Group II, and 24 percent in Group III (the differences were not statistically significant). We conclude that abbreviating methotrexate prophylaxis or infusing donor buffy-coat cells increased the incidence of acute GVHD and related mortality without altering the incidence of chronic GVHD or the recurrence of malignant disease.
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PMID:Graft-versus-host disease as adoptive immunotherapy in patients with advanced hematologic neoplasms. 264 43

Acral erythema after high-dose cytosine arabinoside (Ara-C) has been described as a painful, sharply demarcated, and intense erythema of the palms and soles. This phenomenon occurred and is described in three out of three allogeneic bone marrow transplant (BMT) recipients who received high-dose Ara-C and total-body irradiation for conditioning therapy via the same protocol. These patients also received cyclosporine and methotrexate as prophylaxis for acute graft-versus-host disease. Two of the three patients experienced an increase in the pain associated with acral erythema during cyclosporine infusions and required large doses of narcotic analgesics. Since alcohol intensifies the pain of stomatitis and cyclosporine is manufactured in an alcohol base, the high alcohol content is suspect as the causative factor for this adverse reaction/drug interaction.
Cancer 1989 Jun 15
PMID:Acral erythema secondary to high-dose cytosine arabinoside with pain worsened by cyclosporine infusions. 265 70


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