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)

Plasma concentrations of beta 2 microglobulin (B2M), the light chain of the class I major histocompatibility complex, were measured serially in 26 patients undergoing allogeneic bone marrow transplantation (BMT). The concentrations fell after conditioning treatment, and recovered when the marrow was transplanted. Bacterial infection did not influence B2M concentration, but nine of 22 episodes of acute graft versus host disease were associated with raised concentrations. Increased plasma B2M concentrations were also a feature of eight episodes of chronic graft versus host disease, and these fell after treatment. Reactivation of herpes simplex, varicella zoster, or cytomegalovirus infections were also accompanied by raised B2M concentrations. Three patients with cytomegalovirus pneumonitis had high concentrations of plasma B2M, the rise starting between five and 22 days before onset of symptoms. Although it is non-specific, serial measurement of plasma B2M in patients undergoing BMT may be clinically useful in monitoring chronic graft versus host disease.
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PMID:Changes in plasma beta 2 microglobulin concentrations after allogeneic bone marrow transplantation. 330 8

Among 78 patients who died after bone marrow transplantation, neurologic complications were present in 55 (70%) and were the cause of death in 5 (6%). Metabolic encephalopathy occurred in 29 patients (37%). CNS infections included aspergillosis (3), herpes simplex encephalitis (2), and Listeria monocytogenes meningitis (1). Six additional patients had neuropathologic changes possibly due to cytomegalovirus infection. Cerebrovascular complications occurred in five patients (two hemorrhages and three infarcts). All infarcts were associated with endocarditis. The rate of nonbacterial thrombotic endocarditis was significantly higher (p less than 0.001) than in the general autopsy population. CNS leukemia and therapy-induced injury were rare. There was no evidence of graft-versus-host disease involving the CNS.
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PMID:Neurologic complications of bone marrow transplantation. 388 33

The use of supralethal chemoradiotherapy followed by marrow transplantation has progressed from being an experimental approach applied only to a limited number of end-stage patients to an important therapeutic option appropriate for many adults with a variety of hematologic malignancies. With the use of transplantation, 10% to 30% of patients with relapsed leukemia and approximately 50% of patients with acute nonlymphoblastic leukemia in first remission can be cured. Cures have also been seen in a variety of other hematologic malignancies, including chronic granulocytic leukemia, preleukemia, hairy cell leukemia, and malignant lymphoma. Transplantation is currently limited by the need for a suitable marrow donor; by the complications of the transplant procedure, including infection, graft-versus-host disease, and the toxicities of intensive chemoradiotherapy; and by the risk of recurrent disease. Some of these limitations will likely be overcome as a result of current research. The use of partially matched family members and matched unrelated donors will make transplantation available to more patients. Some forms of posttransplant infection, including those associated with herpes simplex and cytomegalovirus, can now be prevented or treated. Improved methods of controlling graft-versus-host disease including T-cell depletion of marrow and the use of more effective immunosuppressive agents, as well as a better understanding of the toxicities of the preparative regimens, are making the transplant procedure safer and more tolerable. Finally, the development of better preparative regimens and transplantation earlier in the patient's disease course will likely allow for a larger percentage of patients to be cured.
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PMID:Treatment of acute leukemia in adults with chemoradiotherapy and bone marrow transplantation. 388 38

Thirty patients who received bone marrow transplantation treatment from HLA identical sibling donors for immunologic and malignant diseases were studied. In essentially all of the patients oral changes developed during the first 30 days following transplant. Oral symptoms frequently constituted the major complaints of the patients during the follow-up period. The oral changes included mucositis, xerostomia, pain, and bleeding. Mucositis was more severe and of longer duration when associated with herpes simplex infections and when optimal oral hygiene was not maintained. Xerostomia which accompanies engraftment was an early sign of acute graft-versus-host disease. A nonbrushing method of oral hygiene was effective in reducing the severity and duration of mucositis. This technique offers a short-term alternative to brushing in pancytopenic patients who are susceptible to bleeding or trauma.
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PMID:Oral mucositis in patients undergoing bone marrow transplantation. 390 98

In a double-bind controlled study, oral Acyclovir has been compared to a placebo in a series of 39 consecutive patients undergoing bone marrow transplantation. A dose of 200 mg was given every 6 h from day 8 to day 35 after transplantation. Pharmacokinetic studies have shown the good absorption of the drug despite intestinal damage related to chemoradiotherapy or gut graft-versus-host disease (GVHD), there was no sign of toxicity. The protection against herpes simplex virus (HSV) infection was complete in the treated group when compared to the control group even in patients with high anti-HSV antibody titres. The same protection was observed against cytomegalovirus (CMV) infection. The incidence of HSV and CMV was the same in both groups after treatment ended. This study confirms the efficacy of Acyclovir against HSV infection and possibly against CMV infection when it is given prophylactically after bone marrow transplantation.
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PMID:[Use of acyclovir in the prevention of herpes infections after allogenic bone marrow grafts]. 609 Dec 31

T and B cells from one short-term and nine long-term patients who had received HLA-identical bone marrow transplants for aplastic anemia or hematologic malignancy were studied for their ability to synthesize immunoglobulin after in vitro stimulation with pokeweed mitogen, Herpes simplex type 1 antigen, tetanus toxoid, or Epstein-Barr virus. Purified T, OKT4, OKT8, or B cells from patients were cocultured with normal T and/or B cells in the presence of the various stimulants. Multiple regulatory defects were observed in long-term patients with and without chronic graft-versus-host disease. The lymphocytes from the long-term healthy chimeras exhibited fewer defects in their ability to regulate in vitro immunoglobulin synthesis than those of patients with chronic graft-versus-host disease. These findings suggest that the presence of chronic graft-versus-host disease delays or impairs the "rematuration" of the immune system after bone marrow grafting and that the rematurational process occurs at the clonal level.
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PMID:Functional diversity in OKT4 and OKT8 subsets from long-term survivors after HLA-identical marrow grafting. 609 85

In a double-blind controlled study, oral acyclovir was compared with placebo in 39 consecutive patients undergoing bone-marrow transplantation. Acyclovir was given at a dose of 200 mg every 6 h from 8 days before to 35 days after bone-marrow transplantation. Pharmacokinetic studies showed good absorption of the drug, despite intestinal damage related to chemoradiotherapy or gut graft-versus-host disease. There was no sign of toxicity. The protection against herpes simplex virus (HSV) infection was complete in the treated group compared with the placebo group even in patients with high anti-HSV antibody titres before transplantation. The same protection was observed against cytomegalovirus (CMV) infection. The frequencies of HSV and CMV infections were the same in both groups after the cessation of treatment.
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PMID:Prophylaxis of herpes infections after bone-marrow transplantation by oral acyclovir. 613 41

In a double-blind controlled study, oral acyclovir has been compared to a placebo in a series of 39 consecutive patients undergoing bone marrow transplantation. A dose of 200 mg was given every 6 h from day 8 to day 35 after transplantation. Pharmacokinetic studies have shown the good absorption of the drug despite intestinal damage related to chemoradiotherapy or gut graft-versus-host disease (GVHD); there was no sign of toxicity. The protection against herpes simplex virus (HSV) infection was complete in the treated group when compared to the control group even in patients with high anti-HSV antibody titres. The same protection was observed against cytomegalovirus (CMV) infection. The incidence of HSV and CMV was the same in both groups after treatment ended. This study confirms the efficacy of acyclovir against HSV infection and possibly against CMV infection when it is given prophylactically after bone marrow transplantation.
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PMID:Oral acyclovir prophylactic treatment of herpes simplex infection after bone marrow transplantation. 631 95

Bone marrow transplantation is now an accepted component in the overall therapy of acute and chronic (myeloid) leukaemia for some selected patients. Some of the obstacles to success have been partially overcome. Many advances in supportive care have been made. Pneumocystis carinii and herpes simplex infections are preventable. Effective decontamination of the gastrointestinal tract for bacteria and fungi is now readily achievable and may have reduced the risk of serious systemic infections. New antibiotics which, in combination, are effective in life-threatening infections are under study. Recent developments in the prevention or amelioration of graft versus host disease (GvHD) have included T lymphocyte depletion in the donor marrow and the use of the fungal polypeptide cyclosporin A. Less than 10% of patients would now be expected to succumb to this complication. Outstanding problems remaining to be resolved are the improvement in the antileukaemic conditioning prior to transplantation and the prevention or treatment of cytomegalovirus infection in the seropositive recipient. This infection can cause pneumonitis and is currently the single most frequent transplant related cause of mortality.
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PMID:A review of the current status and techniques of allogeneic bone marrow transplantation for treatment of leukaemia. 635 92

Patients who have received marrow transplants and total body irradiation with different forms of chemotherapy should be routinely watched by an ophthalmology service because of the high incidence of dry eye syndrome, viral keratitis, and trophic disturbances of the cornea. Herpes simplex keratitis must be strongly suspected in bizarre corneal findings associated with geographic epithelial denudement accompanying acute GVHD. Acute GVH ocular syndrome warrants clinical recognition when, in the course of severe GVHD, the eyes reveal keratoconjunctivitis with associated herpes simplex infections of the cornea, later to show chronic problems of severe drying conjunctival and corneal scarring compatible with Stevens-Johnson syndrome.
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PMID:Ocular complications in high-dose chemoradiotherapy and marrow transplantation. 702 May 52


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