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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)

122 patients with hematologic malignancies underwent allogeneic marrow transplantation from HLA-matched sibling donors and received one of two forms of infection prophylaxis while granulocytopenic: 1) decontamination and laminar air flow isolation (LAF, 68 patients), and 2) LAF plus prophylactic systemic antibiotics (LAF + PSA, 54 patients). Patients were evaluated for infection acquisition while in isolation. Septicemia occurred in 11 (16%) of the patients in the LAF group and in three (6%) patients in the LAF + PSA group. Fourteen (21%) of the patients in the LAF group and four (7%) patients in the LAF + PSA group had a major local infection. There was no difference in the incidence and severity of graft-versus-host disease or incidence and duration of fever. The addition of prophylactic intravenous broad-spectrum antibiotics for patients isolated in LAF rooms significantly decreased infection acquisition.
Infection
PMID:Laminar air flow isolation and decontamination: a prospective randomized study of the effects of prophylactic systemic antibiotics in bone marrow transplant patients. 308 39

At our Division of Hematology eight clinical studies were performed using ceftazidime alone or in combination with other antibiotics. In the first randomised study ceftazidime (45 patients) proved to be statistically superior (p less than or equal to 0.05) to the combination of cefotaxime and gentamicin (45 patients). The poor results of the latter combination - 49% clinical responses compared with 71% for ceftazidime - have been confirmed by the EORTC study group of Klastersky (1). The second study aimed at 30 patients who failed to respond to cefotaxime and gentamicin. All bacteriologically documented infections were cured with ceftazidime. The clinical response rate was 73%. In the third randomised study we compared ceftazidime plus flucloxacillin in 49 patients in order to extend the spectrum to resistant staphylococci with a ceftazidime monotherapy (51 patients). The addition of flucloxacillin did not improve the results substantially. The overall clinical response rate was 81% with the combination and 85% with ceftazidime alone. In the fourth study on 23 patients with allogenic bone marrow transplantations, receiving cyclosporin A as prophylaxis against graft versus host disease, no nephrotoxic effect was observed. The fifth study comprised 20 patients over 65 years of age, in whom no toxicity different from younger patients was seen. In the sixth study with 51 patients per group we compared ceftazidime with the combination ceftazidime plus cephalothin. This study demonstrated an increased efficacy of the combination against Staphylococcus epidermidis and proved that two different cephalosporins, given simultaneously, are not antagonistic. Analysis of 34 Pseudomonas septicaemias in the seventh study with a clinical success rate of 94% demonstrated clearly the potency of ceftazidime against this particularly dangerous organism.(ABSTRACT TRUNCATED AT 250 WORDS)
Infection 1987
PMID:[Results of several different controlled studies with ceftazidime in the treatment of infections in immunosuppressed patients]. 331 29

The effects of ex-vivo depletion of T lymphocytes from donor bone marrow using a monoclonal anti-T-cell antibody (CT-2) and complement on the outcome of allogeneic bone marrow transplantation was evaluated in a prospective, randomized, double-blind study of 40 patients with leukemia. Patients receiving T-cell-depleted bone marrow had a lower incidence of acute graft-versus-host disease than control patients (3 of 20 compared with 13 of 20; p = 0.004), and mortality due to acute graft-versus-host disease was reduced. Five patients in the T-cell-depletion group developed graft failure; all control patients had sustained engraftment (p less than 0.05). Clinically apparent relapse of leukemia occurred in 7 patients from the T-cell-depletion group and in 2 controls (p, not significant). Cytogenetic evidence of residual leukemia was also detected in the 5 patients with graft failure without overt relapse. Infections and overall survival were similar in the two groups. The effects of T-cell depletion on engraftment and recurrence of leukemia require further evaluation.
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PMID:Treatment of donor bone marrow with monoclonal anti-T-cell antibody and complement for the prevention of graft-versus-host disease. A prospective, randomized, double-blind trial. 352 27

In 11 patients receiving transplants of allogeneic bone marrow, the graft was successful in six. Nine patients developed infections, and six died-five of septicaemia and one of Pneumocystis carinii pneumonia. Fifty individual infections occurred. Predisposing factors included severe underlying diseases, long-term exposure to resistant hospital organisms, heavy immunosuppressive therapy, and graft-versus-host disease. Gram-negative bacilli and Candida albicans were the most common causative organisms. In every instance of septicaemia identical organisms were isolated from blood cultures and simultaneously obtained stool cultures. Infection with exogenous organisms often occurred in patients occupying conventional isolation rooms. Isolation of one patient for 45 days in a laminar air flow room prevented infection with exogenous organisms.
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PMID:Infectious complications in bone marrow transplant patients. 439 26

In a three-week period 7 of 14 transplant recipients were infected with coxsackie A1 virus. Diarrhoea and mortality were significantly associated with infection (7 of 7 infected compared with 0 of 7 non-infected, and 6 of 7 infected compared with 1 of 7 non-infected, respectively). Early in the outbreak, the diarrhoea was presumed to be due to acute graft-versus-host disease (AGVHD). However, the distribution of AGVHD among infected and non-infected patients was nearly equal, and at necropsy 3 of 6 infected patients who had had diarrhoea showed no evidence of gastrointestinal involvement with AGVHD. Infection with viral enteric pathogens may be an important factor in the clinical course of transplant recipients.
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PMID:Outbreak of Coxsackie A1 gastroenteritis: a complication of bone-marrow transplantation. 612 55

Infections occurring 6 mo or later after bone marrow transplantation for severe aplastic anemia or hematologic malignancy were analyzed in 98 long-term survivors. Varicella-zoster (VZ) infections were analyzed separately from all other infections. The factor predisposing most strongly to late VZ infection was genotypic nonidentity for HLA between marrow donor and recipient. There was a suggestion that chronic graft-versus-host disease (GVHD) associated with the presence of nonspecific suppressor cells also predisposed to late VZ infection, while age less than 10 yr was protective against such infections. Chronic GVHD predisposed to late non-VZ infections, but this was not increased by the presence of nonspecific suppressor cells. HLA nonidentify between patient and marrow donor further increased the risk of late non-VZ infections over and above that due to the presence of chronic GVHD. Receipt of a syngeneic transplant appeared protective for late non-VZ infections. These findings suggest that full genotypic identity for HLA between donor and recipient may be required for optimal immune reconstitution after marrow transplantation and may denote a possible biologic role for nonspecific suppressor T cells in humans.
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PMID:Analysis of late infections after human bone marrow transplantation: role of genotypic nonidentity between marrow donor and recipient and of nonspecific suppressor cells in patients with chronic graft-versus-host disease. 621 76

Results of a prospective lung function study are presented for 48 patients with acute myeloid leukemia (AML) treated with total body irradiation (TBI) and bone marrow transplantation (BMT) at the Royal Marsden Hospital between 1978 and 1980. Patients with active disease or who were in remission following cytoreductive chemotherapy had mildly impaired gas exchange prior to grafting. After TBI and BMT all patients studied developed progressive deterioration of lung function during the first 100 days, although these changes were subclinical. Infection and graft-versus-host disease (GvHD) were associated with further worsening of restrictive ventilatory defects and diffusing capacity (DLCO). Beyond 100 days, ventilatory ability returned to normal and gas transfer improved, although it failed to reach pre-transplant levels. There was no evidence of progressive pulmonary fibrosis during the first year after grafting.
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PMID:Lung function after bone marrow grafting. 633 47

Twenty-eight consecutive recipients of HLA-identical sibling marrow grafts received prophylaxis for GVHD with high-dose cyclosporine (CsA) and corticosteroids. CsA 5 mg/kg/day (2.5 mg/kg infused over 4 h twice daily) was started on day -1 and continued until patients could take oral CsA (15 mg/kg/day). CsA doses were adjusted to maintain concentrations between 200-800 ng/ml (whole-blood HPLC) until the tapering period (days 268-361). Methylprednisolone 0.5 mg/kg/day was started on day 7, increased to 1 mg/kg/day during days 15-28, and tapered thereafter until discontinuance on day 194. Low CsA trough levels occurred in 15 patients (54%) during the i.v. administration period. Ten patients (36%) developed grade I and 3 patients (11%) developed grade II acute GVHD; there were no cases of grade III or IV disease. The actuarial incidence of chronic GVHD was 29% at 1 year but 57% at 2 years due to development of chronic GVHD after discontinuation of immunosuppressive agents. High blood CsA concentrations in stable outpatients led to dose-limiting nephrotoxicity. Infections occurred throughout the period of extended immunosuppression (from 6 to 12 months) but were not life-threatening. The actuarial incidence of leukemic relapse was 18% at 1 year and 25% at 2 years. Actuarial survival at 1 and 2 years was 68 and 51%, respectively. Despite the frequent occurrence of low CsA trough levels, this regimen appeared to be effective in preventing acute GVHD. Immunosuppressive prophylaxis beyond 1 year may be required to reduce late-onset chronic GVHD.
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PMID:High-dose cyclosporine and corticosteroids for prophylaxis of acute and chronic graft-versus-host disease. 758 Nov 15

An acute graft versus host disease (GvHD) murine model was developed to study the pathogenic and protective mechanisms against viruses that replicate in cells of the human immune system. The model allowed efficient replication of lymphotropic, macrophage and amphitropic strains of human immunodeficiency virus type 1 (HIV-1) and measles virus (MV). Cytopathic lymphotropic strains of HIV-1 and a wild-type MV strain replicated in a 'burst'-like manner, whereas a non-cytopathic lymphotropic HIV-1 strain and all macrophage-tropic HIV-1 strains caused persistent infection of the graft. The replication kinetics of infection with these viruses were highly reproducible and were very similar to those observed in natural infection of humans. Infection with these viruses, with the exception of HIV-1SF2, led to a delay [corrected] and abrogation of the GvHD, indicating a direct immunosuppressive effect. Interestingly, infection with the lymphotropic HIV-1SF2 strain was rapidly and spontaneously abrogated. The model was also shown to be suitable for the evaluation of passive immunization strategies. Administration of a combination of antibodies against the HIV-1 V3 loop and the HIV-1 CD4 binding sites prevented subsequent infection with HIV-1IIIB. In contrast, administration of CD4 binding site specific human monoclonal antibody at a concentration that would neutralize the virus in vitro enhanced in vivo infection with HIV-1IIIB. The model also allowed evaluation of in vivo immunization studies. Immunization with a live attenuated measles vaccine resulted in protection from a wild-type MV challenge, whereas immunization with a subunit candidate vaccine appeared to give partial protection.
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PMID:Efficient replication of human immunodeficiency virus type 1 and measles virus in a human-to-mouse graft versus host disease model permits immunization research. 759 77

Infection with nocardia is rare in BMT patients. We described the first reported case of pulmonary nocardiosis in an allogeneic marrow recipient with graft-versus-host disease. The patient developed nocardial infection while receiving trimethoprim-sulfamethoxazole as prophylaxis against Pneumocystis. The salient clinical presentation was right lower lung consolidation; the diagnosis was established by prolonged incubation of an open lung biopsy specimen. Antibiotic therapy included timentin and later, imipenem. However, the patient died with uncontrolled infection. Necropsy revealed nocardial lung abscesses and disseminated infection from cytomegalovirus.
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PMID:Pulmonary nocardiosis in a patient with a bone marrow transplant. Bone Marrow Transplantation Team. 759 76


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