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)

Data from 137 patients who underwent allogeneic marrow transplantation for aplastic anemia and who had sufficient virologic and serologic surveillance data were reviewed for risk factors for cytomegalovirus (CMV) infection and associations between CMV infection and acute or chronic graft-versus-host disease (GVHD). Total CMV infection (i.e. excretion or seroconversion) occurred in 58% of the patients. Twelve patients (9%) developed CMV pneumonia. Among seropositive patients occurrence of acute GVHD was associated with increased risk of total CMV infection and CMV excretion, but not of seroconversion. Acute GVHD did not influence the likelihood of total CMV infection, excretion, or seroconversion in seronegative patients. Among seronegative patients marrow donor seropositivity, buffy coat infusions, and granulocyte transfusions were significant risk factors for total CMV infection and seroconversion, but not for CMV excretion. No influence of either total CMV infection or the patient's or donor's serologic status for CMV was found on the risk of developing chronic GVHD in this homogeneous group of patients who underwent allogeneic marrow transplantation for aplastic anemia.
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PMID:Cytomegalovirus infection after marrow transplantation for aplastic anemia. 196 36

Cytomegalovirus (CMV) is the most common cause of interstitial pneumonia following bone marrow transplantation. CMV pneumonia (CMV Pn) is particularly worrying after allografts since its incidence and severity are closely linked to graft-versus-host disease (GVHD). In similarly conditioned patients, the risk of CMV Pn is the same after autografts and allografts without GVHD; it is inexistant in bone marrow transplantations between twins. These findings, together with numerous experimental data, make CMV Pn a model of viral pneumonia in which the severity of the pneumonia seems to correlate mainly with an immunological reaction that is toxic for pulmonary cells, and CMV acts as a triggering agent rather than as a direct pathogen. As regards treatment, the ganciclovir-immunoglobulins combination has been very encouraging in the first patients treated, but as its mode of action is uncertain our enthusiasm must be tempered, especially since the results recently obtained in a greater number of patients seems to be less favourable than the initial results. The effectiveness of this costly drug combination, which in practice should be reserved for patients who received allografts or autografts plus pulmonary radiotherapy, deserves a more precise re-evaluation.
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PMID:[Clinical, diagnostic and physiopathological aspects of cytomegalovirus pneumonia after bone marrow transplantation]. 196 51

At Huddinge Hospital 275 patients underwent allogeneic bone marrow transplantation. Among children in first remission of acute leukemia or chronic phase CML (early leukemia), with HLA-identical marrow the 8-year leukemia-free survival was 77%. This was better than 38% in children undergoing transplantation in second to fourth remission (p less than 0.0009). In adults with early leukemia, the 8-year leukemia-free survival was 47% compared to 21% for intermediate-risk adults (p = 0.007). Among 25 patients with severe aplastic anemia receiving marrow from HLA-identical siblings, the actuarial 10-year survival was 78%. In 14 patients with various metabolic disorders, of whom half received marrow from HLA-mismatched donors, the actuarial 7-year survival was 71%. Forty-three patients were given marrow from HLA-mismatched donors and had an increased incidence of acute graft-versus-host disease (GvHD) and death due to GvHD compared to recipients of HLA-identical bone marrow. The major causes of death among our patients were relapse of leukemia, death due to GvHD, cytomegalovirus (CMV) pneumonitis, bacterial infection and invasive fungal infections. By preventing GvHD with T-cell depletion or methotrexate (MTX) combined with cyclosporine (CsA) acute GvHD decreased, but the incidence of relapse increased compared to patients treated with MTX or CsA alone. This resulted in improved survival in patients older than 30 years, but a nonsignificant decrease in leukemia-free survival in younger patients. There was an association between herpes virus immunity in the recipient and GvHD. CMV pneumonitis increased following GvHD and decreased in patients treated with MTX combined with CsA. Invasive fungal infections may be treated or prevented using amphotericin B encapsulated in liposomes with few side effects.
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PMID:Allogeneic bone marrow transplantations at Huddinge Hospital and strategies to improve survival. 210 43

Eighteen patients with leukemia have received HLA-identical allogeneic bone marrow transplantation (BMT) at our hospital since 1981. Fifteen of these patients have been living without relapse. for prophylaxis of GVHD, MTX was used in 8 patients, and cyclosporine (CSP) together with MTX in 6 patients, 3 received multiple agents at much smaller dosage, including monoclonal antibody. All patients received intravenous placental gamma-globulin, and 16 received garlic extract. Three patients died. One, who neither received MTX, nor CSP died of hyperacute GVHD, one who did not receive garlic extract died of GMV pneumonia, and the third one died of tuberculosis 18 months after BMT.
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PMID:Allogeneic bone marrow transplantation for the treatment of leukemia. 211 28

Thirty-four patients received bone marrow transplants from unrelated donors. Donors and recipients were phenotypically matched for 6 of 6 HLA-A, B, and DR antigens in 27 cases and at 5 of 6 antigens in 7 cases. Twenty-three patients had leukemia, six had myelodysplasia, and five had aplastic anemia. Twenty-four patients had durable engraftment. Five died of sepsis prior to engraftment. Five patients failed to engraft; 2 of these patients had autologous bone marrow recovery. Seventeen patients developed grade greater than or equal to II acute graft-versus-host disease for an actuarial probability of 67 +/- 20%. The severity of acute graft-versus-host disease and its mortality appeared increased for recipients matched for 5 of 6 HLA-A, B, and DR antigens. Of the 34 patients, 13 (38%) are alive; actuarial survival beyond 6 months is 44 +/- 17%. None of the 25 leukemia and myelodysplasia patients achieving engraftment have relapsed. For leukemia and myelodysplasia recipients of 6 of 6 HLA-matched grafts, actuarial survival at 6 months was 55 +/- 21% compared with 14 +/- 26% for recipients matched for 5 of 6 HLA loci (P = 0.19). Infection and acute graft-versus-host disease were the primary causes of death in the engrafted patients. Survival for aplastic anemia patients was 20%. Late deaths due to pneumonia and bronchiolitis obliterans occurred after one year in 2 patients. Closely matched unrelated donor bone marrow transplants are associated with a higher incidence of graft failure and graft-versus-host disease than typically reported for transplants from HLA-identical siblings, but these preliminary data suggest a lower rate of relapse.
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PMID:Bone marrow transplantation using unrelated donors for patients with advanced leukemia or bone marrow failure. 214 25

Following bone marrow transplantation, patients are profoundly immunodeficient and susceptible to a variety of opportunistic infections. The types of infections vary during different intervals after transplantation. Before engraftment, neutropenia and damaged mucosal surfaces are the predominant deficits in host defenses against infection, and bacterial and fungal infections are the most common infections encountered. During the early post-engraftment period, acute graft-versus-host disease and its treatment result in a severe deficiency of cellular immunity. Cytomegalovirus infection is frequent and can result in life-threatening pneumonia. Fungal infections are also common. After the first three months, infection is much less common. However, reactivation of varicella-zoster virus (VZV) and infections with certain pathogens such as Pneumocystis carinii, can occur due to still-impaired cellular immunity.
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PMID:Management of infectious complications of bone marrow transplantation. 214 70

Bronchoalveolar lavage (BAL) cytology and immunoglobulin components of lavage fluid were studied during non-bacterial/non-fungal interstitial pneumonitis, bacterial/fungal pneumonia, and Pneumocystis carinii infection. Lavages done before bone marrow transplantation and in asymptomatic phases were used as controls. The total cell recovery was increased during lung processes of any aetiology. Non-bacterial/non-fungal pneumonitis caused a significant increase in the number of lymphocytes; the number of neutrophils increased particularly during bacterial pneumonia. In Pneumocystis carinii pneumonia the typical cell picture was an increased percentage of lymphocytes together with blasts. During acute graft-versus-host disease without respiratory symptoms the cytology in lavage fluids did not differ from the controls. Cytomegalovirus (CMV) isolation was frequently positive in lavage fluids regardless of the presence or absence of pulmonary symptoms, but most of the symptom-free CMV-positive patients did not have any marked changes in BAL cytology. The albumin content of BAL fluid increased during infectious and immunological processes in lungs.
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PMID:Use of bronchoalveolar lavage cytology and determination of protein contents in pulmonary complications of bone marrow transplant recipients. 215 19

We prospectively studied the presence of cytomegalovirus in bronchoalveolar lavage through virus isolation in 21 bone marrow transplant recipients before and after transplantation. All 14 lavage specimens collected before bone marrow transplantation were negative for cytomegalovirus. During the period from 20 to 90 days after transplantation, 12 of 24 lavage specimens (50%) from 14 patients without lung problems were positive for cytomegalovirus. Cytomegalovirus was isolated from 4 of 10 lavage specimens (40%) in 7 patients with pneumonia during the same interval. We conclude that culture for cytomegalovirus in bronchoalveolar lavage fluid is not a reliable method for establishing the virus's causative role in pneumonia soon after bone marrow transplantation. Among 14 patients in whom bronchoalveolar lavage was done at an asymptomatic stage, 6 of 9 patients with cytomegalovirus and none of 5 without cytomegalovirus in the lavage fluid later developed pneumonia. All of the patients subsequently developing pneumonia also had acute graft-versus-host disease, suggesting an immunopathologic mechanism, possibly triggered by cytomegalovirus, for cytomegalovirus-associated pneumonia.
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PMID:Cytomegalovirus is frequently isolated in bronchoalveolar lavage fluid of bone marrow transplant recipients without pneumonia. 216 Feb 16

Allogeneic marrow transplantation has emerged as a curative therapy for many patients with acute leukemia. The ability to cure patients of their disease is dependent on the remission status of the patient. For patients with acute myelogenous leukemia, up to 60% of patients can become long-term, disease-free survivors, whereas a similar number of patients with high-risk acute lymphoblastic leukemia can also achieve cure of their disease. The improved results with marrow transplantation have allowed the application of this therapy for patients up to the age of 50 years. Even patients with therapy-related leukemias can benefit from this approach. Although relapse is still a problem in all remission stages, current studies suggest that improved preparatory regimens, in combination with better treatment of graft-versus-host disease and prevention of cytomegalovirus pneumonia, will continue to improve the overall results of this therapy for patients with acute leukemia.
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PMID:Allogeneic bone marrow transplantation for acute leukemia. 219 12

A 36-year-old man was diagnosed as having RAEB in 1986, and required blood transfusion regularly because of severe anemia. He received the first bone marrow transplantation following total-body irradiation and etoposide infusion in October 1987. He was found to be relapsed into RAEB on 106th day after BMT. And the second BMT was planned. According to the conditioning regimen of Tutschka, et al, we administrated busulfan and cyclophosphamide before re-transplantation. On 26th day after BMT, the WBC count exceeded 1,000/microliters and anemia was improved, while thrombocytopenia persisted until 50th day. Normal hematopoiesis in the bone marrow was confirmed on the 29th day. No severe side effect except for a little fevering and bleeding was found during the clinical course. Unfortunately he died of pneumonia following graft versus host disease on the 166th day after re-BMT. This new conditioning regimen is considered to be a choice for the high risk patients on re-transplantation.
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PMID:[Bone marrow re-transplantation following a busulfan and cyclophosphamide regimen]. 221 94


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