Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018133 (graft-versus-host disease)
 18,032 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixteen patients with haematological malignancy received high-dose chemotherapy or chemotherapy and total body irradiation followed by an HLA-identical sibling marrow transplant from which the T lymphocytes had been depleted prior to infusion by incubation with an anti-CD2 anti-T cell antibody with (seven patients) or without (nine patients) an anti-CD8 anti-T cell antibody together with rabbit complement. Additionally, all patients received cyclosporin. The number of T cells present in the donor marrow was determined by limiting dilution analysis, and was found to correlate with the subsequent incidence and severity of acute graft-versus-host disease (GVHD). The number of T cells infused into patients with no acute GVHD or with minimal acute GVHD of the skin (skin rash present for 14 days or less) was 1.3 +/- 1.0 x 10(5)/kg, while the number infused into those with moderate acute GVHD or with skin acute GVHD present for 15 days or more was 12.3 +/- 11.5 x 10(5)/kg (p less than 0.001). Thus a dose of 10(5) (or less) T cells/kg was associated with minimal or no acute GVHD, while 10(6) T cells/kg (or more) caused significant disease.
 ...
PMID:Human marrow T cell dose correlates with severity of subsequent acute graft-versus-host disease. 333 57

Punch biopsies of skin were taken from allogeneic marrow recipients routinely before transplantation, at 14-22 and 90-107 d after grafting and in the event of a clinical rash. Three histological appearances were encountered: graft versus host disease (GvHD), epidermal abnormalities, and normal. Graft versus host disease was characterized by epidermal basal vacuolation, spongiosis and individual cell necrosis associated with mononuclear cell infiltration of the upper dermis and lower epidermis, while epidermal abnormalities were identical to GvHD but without the mononuclear cell infiltrate. Graft versus host disease occurred only in patients receiving marrow unpurged of T-cells while epidermal abnormalities occurred with equal frequency in recipients of purged and unpurged marrow and were also noted in a high proportion of pre-transplant biopsies. Patients whose skin biopsies exhibited epidermal abnormalities showed no greater incidence of subsequent clinical or histological GvHD than those with normal biopsies. For these reasons, we conclude that epidermal abnormalities cannot be regarded as a minor manifestation of GvHD as has often been previously assumed. We also conclude that they cannot be regarded as the cause of a rash as, unlike GvHD, the incidence was not significantly different in patients with and without rashes. The cause of epidermal abnormalities is not entirely clear; cytotoxic drugs and irradiation appear to play a part but their occurrence in patients with previously normal post-transplant biopsies suggests that other factors may also be important. Some patients with strong clinical evidence of GvHD had negative biopsies; these should be regarded with caution especially within the first 24 h after the onset of a rash as the diagnostic histological picture may take time to develop. In some cases, GvHD was confined to pilosebaceous units; this seems to represent a minor form of the disease with only a limited capacity for progression. Dysplastic epidermal changes which have previously been attributed to the use of cyclosporin A were found with equal frequency in patients who did not receive this drug and must therefore have some other cause.
 ...
PMID:The histological diagnosis of cutaneous graft versus host disease: relationship of skin changes to marrow purging and other clinical variables. 355 28

The major limitation of mismatched bone marrow transplantation is fatal graft versus host disease (GVHD). We processed haplotype-identical parental marrow with soybean agglutinin (SBA), sheep erythrocytes (SRBC), and neuraminidase-treated SRBC (N-SRBC) to enrich for marrow stem cells and remove mature T cells. Nine patients with severe combined immunodeficiency disease (SCID) who lacked histocompatible donors received these SBA-negative, SRBC-negative, N-SRBC-negative marrow transplants (0.5-5.0 X 10(8) cells/kg). Seven of the nine patients (78%) had documented T-lymphocyte engraftment based on HLA typing and/or chromosomal analysis. Six patients showed evidence of B-cell immunity on the basis of increased immunoglobulin levels, isohemagglutinins, and/or HLA-DR typing of non-T cells. Three patients received marrow ablative chemotherapy pretransplant for maternal-fetal GVHD; neutrophil engraftment occurred between 9 and 17 days posttransplantation, erythrocytes engrafted within 3-4 weeks of transplantation, and platelet recovery was seen between day 17 and day 49 following the transplants. No immunosuppression was given prophylactically posttransplant. Three patients had no GVHD, two had transient rash and/or fever, and two developed mild focal (stage I) chronic cutaneous GVHD. Of the seven who engrafted, five (71%) are alive and clinically well without GVHD 18-35 months posttransplant. These data demonstrate that SBA- and SRBC/N-SRBC-treated haploidentical marrow transplantation results in functional lymphocyte engraftment in SCID without significant GVHD, and can be used for some patients who otherwise would have no hope for survival.
 ...
PMID:Haploidentical bone marrow transplantation for severe combined immunodeficiency disease using soybean agglutinin-negative, T-depleted marrow cells. 391 Jun 75

A 50-year-old severely immunodeficient woman with malignant non-Hodgkin lymphoma died from graft-versus-host disease due to transfusion of a single unit of packed red cells. Three days after this transfusion a maculo-papular rash appeared, followed by generalized erythroderma refractory to therapy and eventually progressing into generalized ulcero-squamous dermatitis. This case, and a review of other similar cases published elsewhere, prompt the authors to recommend prophylactic irradiation of blood products prior to their administration to patients with cellular immunodeficiency, particularly in cases of acute leukaemia or malignant lymphoma where patients receive intensive radio- and/or chemotherapy regimens. To appreciate the degree of cellular immunodeficiency in such risk patients, simple criteria should be developed to assess the efficiency of the cellular immune system.
 ...
PMID:[Acute graft-versus-host disease following a single transfusion of erythrocytes]. 396 40

The ability to define subpopulations of immunologically competent lymphocytes has permitted an enhanced understanding of the interaction between functionally distinct components of the immune system. T cells can provide help in antibody formation or they may suppress antibody production. Abnormal immunoregulatory mechanisms have been demonstrated in the hyperimmunoglobulin E-recurrent infection syndrome. This disorder is associated with a marked elevation of IgE and specific elevations of IgE antibodies directed toward staphylococcal antigens. Abnormal T cell regulation of immune responses has been demonstrated. Graft-versus-host disease (GVHD) occurs in an immunodeficient patient who has received an infusion of immunocompetent cells. The diagnosis of graft-versus-host (GVH) reaction may be complicated by the protean manifestations of the disorder. The acute form, consisting of a maculopapular rash, fever, and diarrhea, may be confused with acute infection or drug reaction. Chronic GVHD has been incorrectly diagnosed as histiocytosis X, acrodermatitis enteropathica, or scleroderma. Utilizing chromosome markers and/or identification of histocompatibility antigens, the presence of circulating lymphocytes from donor immunocompetent cells (blood transfusion, maternal source) can be documented. The development of sensitive technics for identifying cells can establish a precise diagnosis. Certain immunodeficiency disorders can be identified by biochemical means. Biotin-dependent multiple carboxylase enzyme deficiency is associated with a chronic dermatitis, alopecia, ataxia, and secondary infection of the skin with Candida. The disorder responds promptly to the administration of biotin with correction of dermatologic, neurologic, and immunologic abnormalities.
 ...
PMID:New insight into the causes of immunodeficiency disorders. 638 1

Mucocutaneous reactions to graft versus host disease may be acute (maculopapular rash, scarlatiniform rash, epidermal necrosis), related to T lymphocyte aggression to basal layer cells, or chronic (lichenoid, or even poikilodermic and sclerous lesions) when a complex mechanism is involved. The syndrome sicca is a major manifestation of graft versus host disease of a chronic type, histology showing moderate lymphocyte infiltration and then marked fibrosis.
 ...
PMID:[Mucocutaneous and salivary manifestations of the graft vs host reaction after bone marrow transplantation]. 639 13

Twenty-one patients, 18 with leukemia and three with severe aplastic anemia, were treated by allogeneic bone marrow transplantation. Acute graft-versus-host disease (GVHD) developed in 13 patients (62%), of whom nine (69%) had grade I, two grade II, one grade III and one grade IV. In all nine patients with grade I, elevation of the serum glutamic pyruvic transaminase level without an increase in the serum bilirubin level was observed, which suggested the presence of GVHD in the liver. All 11 patients with grade I and II responded well to therapy with predonisolone. Eleven (73%) of the 15 patients who survived for more than 100 days after marrow transplantation developed chronic GVHD. As signs of chronic GVHD, hepatic disturbances were observed in nine patients (82%), while exanthema, ophthalmic symptoms and oral mucosal symptoms were observed in seven (64%), six (55%) and four (36%), respectively. These symptoms could be well controlled by predonisolone combined with either azathioprine or cyclosporin A. Of the five deaths following the onset of chronic GVHD, three were due to interstitial pneumonitis, one to sepsis and one to relapse of the leukemia. Karnofsky's performance scores of five of the six surviving patients with chronic GVHD were 90%. Six patients with acute leukemia were still alive more than six months after marrow grafting. None of them have shown recurrence of leukemia. Five of these six had chronic GVHD.
 ...
PMID:Graft-versus-host disease following allogeneic bone marrow transplantation. 639 14

2 fatal cases of graft-versus-host disease (GvHD) occurred following blood product transfusions given to patients receiving standard chemotherapy for Hodgkin's disease. GvHD was established by HLA typing, clinical course, and compatible skin biopsy. 23 cases of GvHD following transfusion of blood products from normal donors are also reviewed. It should be suspected when fever or rash appear 1-2 weeks after transfusion of unirradiated blood products into a compromised host or when pancytopenia following chemotherapy is prolonged or unexpectedly severe. Prevention of GvHD by irradiation of granulocytes, platelets and packed red blood cells given to immunosuppressed patients is recommended to prevent this often fatal disease.
 ...
PMID:Acute graft-versus-host disease resulting from normal donor blood transfusions. 642 40

Graft versus host disease (GVHD) is a well recognized entity following bone marrow transplantation. Similar syndromes have been described after blood product transfusions, notably in patients with primary immunodeficiency syndromes and in patients with malignancies associated with immune deficiency or under immunosuppressive treatment. Review of the literature shows that posttransfusion GVHD is characterized by maculopapular skin rash, gastro-intestinal symptoms, liver disease, severe pancytopenia and, in some cases, hepatosplenomegaly and lymphadenopathy. The time to onset and the duration of the disease are short (10 days) and the mortality approaches 90%. The clinical features of this rare disorder are presented in the hope that, with increased awareness of this complication, clinicians will take preventive measures in patients at risk because no satisfactory therapy yet exists.
 ...
PMID:[Clinical characteristics and evaluation of risk in the graft versus host reaction following transfusion]. 663 42

Following allogeneic bone marrow transplantation, graft-versus-host disease (GVHD) develops when the foreign donor lymphoid graft mounts an immunologic reaction against the skin, liver, and gastrointestinal tract of the host. The GVHD syndrome is characterized by skin rash, hepatocellular dysfunction, and secretory diarrhea with destruction of intestinal mucosa. The gastrointestinal radiographic manifestations of proven GVHD were studied in 16 allogeneic marrow recipients transplanted for aplasia (nine) or leukemia (seven). The radiographic findings revealed three distinct phases that correlated with the duration of active gastrointestinal GVHD: (1) Acute phase-seven examinations were performed 4-15 days after the onset of gastrointestinal GVHD, 19-44 days posttransplant. There were simultaneous and uniform changes in the stomach through the small bowel consisting of thickened or flattened mucosal folds, thickening of the bowel wall, rapid transit, and excess luminal fluid. (2) Subacute phase-17 examinations were performed 13-96 days after the onset of gastrointestinal GVHD (40-118 days posttransplant). Abnormalities similar to those of the acute phase were noted, often with a striking segmental distribution. (3) Resolution phase-three patients, who earlier had sequential examinations, were studied when GVHD was no longer clinically active, 43-46 days after the onset of gastrointestinal GVHD (52-94 days posttransplant). These examinations showed improvement, with no abnormalities or effacement of mucosal folds. Mural thickening was confined to the terminal ileum. Gastrointestinal GVHD resolved in the three survivors; it persisted until death in nine of 13. The pathogenic mechanisms and differential diagnosis of the radiographic abnormalities are discussed.
 ...
PMID:Gastrointestinal radiographic features of human graft-vs.-host disease. 678 Dec 55


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>