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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)

Pediatric bone marrow transplantation and transplantation of solid organs rapidly expanded during the 1980s. Antibiotic therapy for bacterial pneumonias, improved transplant preparative regimens, and improvements in prevention and therapy of graft-versus-host disease have made possible significant improvements in overall bone marrow transplant survival. Despite these advances, pulmonary complications of transplantation remain major causes of morbidity and mortality in pediatric transplant patients. Fungal and cytomegalovirus infections have emerged as the major posttransplant pulmonary infections whereas idiopathic interstitial pneumonias and bronchiolitis obliterans are the major noninfectious pulmonary problems. Recent developments in antiviral therapy for cytomegalovirus pneumonia offer hope that the dismal prognosis of cytomegalovirus pneumonia in transplant patients can be improved. New early detection methods for cytomegalovirus using polymerase chain reaction may also help identify patients for prophylactic therapy and prevent development of cytomegalovirus pneumonitis. Early diagnosis and treatment for fungal pneumonias and other opportunistic pathogens remain significant challenges in immunocompromised transplant patients.
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PMID:Pulmonary complications of tissue transplantation in children. 806 36

The number and types of mononuclear cells obtained by bronchoalveolar lavage from 105 marrow transplant patients with and without cytomegalovirus pneumonia were studied to determine whether: (1) CMV pneumonia was associated with local recruitment of lymphocytes and lymphocytes of particular subtypes to the lung, and (2) whether local recruitment was affected by the known risk factors for the development of CMV pneumonia, namely acute graft-versus-host disease and total body irradiation. Results showed a significant increase in the number of lymphocytes (P = 0.014) and in the number of lymphocytes marking for CD8 (P = 0.0045) and CD16 (P = 0.052) in BAL from all patients compared with BAL from normal subjects. However, no significant differences were observed in BAL cellular characteristics between patients with and without pneumonia nor between patients with CMV or other etiologies of pneumonia. There were also no significant differences in BAL characteristics when patients were analyzed for the presence of acute GVHD, the use of TBI, or the type of transplant. These results do not provide evidence for local recruitment of lymphocytes to the lung unique of patients with CMV pneumonia nor to patients with GVHD and CMV pneumonia, in contrast to what is observed in murine CMV pneumonia.
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PMID:Mononuclear cell reconstitution in the lung after marrow transplantation. Lack of influence of cytomegalovirus pneumonia, irradiation, and graft-versus-host disease. 809 99

Three pediatric patients of a cohort of 24 who underwent allogeneic bone marrow transplantation (BMT) from matched unrelated or mismatched family member donors developed low grade fever and cough between 2 and 3 months after BMT in the absence of clinical GVHD. Imaging studies revealed bilateral patchy opacities and open lung biopsies revealed the characteristic histological appearance of bronchiolitis obliterans organizing pneumonia. All three patients were treated with steroids and in two patients the syndrome resolved over 1-2 months; the third patient developed progressive pulmonary failure and died 2 weeks after diagnosis. BOOP may be an under-recognized respiratory complication following BMT from a matched unrelated donor or mismatched family member.
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PMID:Bronchiolitis obliterans organizing pneumonia (BOOP) in children after allogeneic bone marrow transplantation. 820 95

A 39 year old patient diagnosed of severe aplastic anemia and treated with allogenic bone marrow transplantation and who presented chronic eosinophilic pneumonia eight months after the transplant is presented. The patient had no previous history of asthma or atopy. Conditioning was performed with cyclophosphamide and total body irradiation. Prophylaxis of the graft versus host disease was carried out with cyclosporin and short course of methotrexate. At day 30 mild graft versus host disease appeared which spontaneously resolved. A progressive increase in the number of eosinophils was observed from day +40 reaching 1.05 x 10(9)/l at day +180 coinciding with suspension of the cyclosporine. The patient remained asymptomatic with no evidence of chronic graft versus host disease. At 8 months following allogenic transplantation the patient developed three episodes of fever, cough, moderate dyspnea and pulmonary infiltrates. Respiratory tests showed a restrictive pattern. Bronchoalveolar lavage contained 20% of eosinophils. Upon lung biopsy alveolar infiltration by eosinophils, lymphocytes and mononuclear cells was observed. Diagnosis of chronic eosinophilic pneumonia was made with initiation of steroid treatment. A drastic response was observed. The patient remained asymptomatic without recurrence and without evidence of chronic graft versus host disease. This picture may have been caused by the donor eosinophils given that retrospective evaluation demonstrated a persistent moderate eosinophilia in the donor.
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PMID:[Chronic eosinophilic pneumonia in a patient treated with allogenic bone marrow transplantation]. 820 96

Ganciclovir which has proved effective in the treatment of cytomegalovirus (CMV) infection was given prophylactically to 40 bone marrow transplant (BMT) patients pre and post-transplant in seropositive patients and post-transplant in seronegative patients with a seropositive donor. All patients were transfused with screened blood products and 33 received CMV hyperimmune globulin. They were compared with an historical control group consisting of 39 patients who had received significantly more unscreened blood products (p = 0.01) and less HLA-mismatched marrow transplants (p = 0.05). Toxicity of ganciclovir was hematological-neutropenia was responsible for cessation of the drug in seven patients and transfusion requirements were significantly higher in the ganciclovir group. Non-hematological toxicity did not occur in any patient. Only one patient (2.5%) experienced symptomatic CMV infection and no patient developed CMV pneumonitis. In contrast, in the control group, 23 (59%) patients had clinical symptoms of CMV infection (p < 0.0001) and 4 (10%) experienced CMV pneumonitis (p < 0.01). Ganciclovir significantly reduced the incidence of positive CMV antigenemia (7.5% in the treated group vs 72% in the control group; p < 0.01). However, ganciclovir delivery did not result in an improved overall survival due to a higher rate of regimen-related deaths and chronic GVHD mostly in patients transplanted from an HLA-mismatched donor. The prophylactic administration of ganciclovir abrogates CMV pneumonitis and considerably reduces the incidence of CMV infection in BM recipients at high risk of developing this disease after transplantation.
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PMID:Prophylactic use of ganciclovir for allogeneic bone marrow transplant recipients. 824 76

The risks for the development of idiopathic pneumonia after allogeneic BMT were assessed in a case-series review at a single marrow transplantation center. All allogeneic marrow recipients (n = 299) (age range 1-60 years) with severe aplastic anemia (SAA) transplanted from family member donors after conditioning with CY were evaluated. Post-grafting immunosuppression consisted of MTX alone in 205 patients (69%), CY alone in 16 (5%) and a combination of the two in 78 (26%). The incidence estimate for any pneumonia within the first 200 days after transplant was 18% (95% confidence interval = 14-24%). Of 48 cases of pneumonia, CMV infection was documented in 44%, 21% were idiopathic and the remainder were either due to other infections or were not evaluated. The effect of acute GVHD on the incidence of pneumonia was examined using multivariate Cox proportional hazards models which included covariates for potential confounding factors. Consistent with previous reports, acute GVHD was associated with an increased incidence of any pneumonia (relative risk (RR) = 3.5, 95% Cl = 1.9-6.9; p < 0.001). Specifically, acute GVHD also was associated with the largest risk of idiopathic pneumonia (RR = 5.0, 95% Cl = 1.1-22; p = 0.04). In conclusion, recognition of acute GVHD as a risk factor for idiopathic pneumonia suggests that mechanisms in addition to chemoradiation damage are responsible for non-infectious lung injury after BMT.
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PMID:Acute graft-versus-host disease and the risks for idiopathic pneumonia after marrow transplantation for severe aplastic anemia. 824 81

To assess the efficacy of immune globulin in preventing CMV infection, interstitial pneumonia, GVHD and death after BMT, we reviewed and synthesized data from 12 published studies (with 1282 patients) in which immune globulin was used prophylactically in BMT patients, controls were included and clinical outcomes were assessed. Data synthesis indicates that immune globulin significantly reduces fatal CMV infection (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.23-0.99), CMV pneumonia (OR 0.61, CI 0.42-0.89), non-CMV interstitial pneumonia (OR 0.57, CI 0.35-0.95) and total mortality (OR 0.74, CI 0.55-0.99). The reduction in acute GVHD was not quite significant (OR CI 0.45-1.02). Complications decrease with both hyperimmune and conventional immune globulin. For CMV-negative transplant recipients, immune globulin decreases symptomatic CMV infection (OR 0.55, CI 0.31-0.94) and interstitial pneumonia (OR 0.34, CI 0.15-0.77). For CMV-positive recipients, immune globulin prevents interstitial pneumonia (OR 0.45, CI 0.26-0.80) but not symptomatic CMV infection (CI 0.41-2.80). We conclude that immune globulin is efficacious in preventing major complications of BMT in both CMV-negative and CMV-positive recipients.
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PMID:Efficacy of immune globulin in preventing complications of bone marrow transplantation: a meta-analysis. 824 87

Chronic myelogenous leukemia (CML) is a uniformly lethal malignant disorder of the hematopoietic stem cell. Although CML cannot be cured with conventional therapy, recent results suggest that therapy with marrow transplantation may prolong survival and, in some cases, provide curative therapy. Approximately 30% of otherwise eligible marrow transplant candidates have an HLA matched or one antigen mismatched related donor. Related donor marrow transplantation therapy for patients in the chronic phase of CML results in 45-70% long-term, disease-free survival. Younger recipient age, transplant in chronic rather than advanced phase and transplant within one year of diagnosis provide a better outcome. Graft versus host disease (GVHD), pneumonia and systemic infections are commonly encountered complications. T-lymphocyte depletion of donor marrow reduces the incidences of acute and chronic graft versus host disease but is associated with a higher relapse rate and lower overall incidence of disease-free survival than use of non-T-depleted marrow. The use of HLA matched or one antigen mismatched unrelated donors allow successful marrow transplantation in approximately 30% of CML cases where a suitably matched related donor is not available. Unrelated donor marrow transplantation can provide stable engraftment in the majority of recipients and lead to leukemia-free survival in many cases. The beneficial effects of unrelated donor marrow transplantation are particularly apparent in young, chronic phase recipients and when performed using donor/recipient pairs identical at the HLA A, B and DR loci. A higher incidence of graft failure and GVHD than observed in sibling marrow transplant as well as prolonged convalescence in some cases can be anticipated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of CML with unrelated donor marrow transplant. 825 98

For the differential diagnosis of pulmonary infiltrates after bone marrow transplantation, cytomegalovirus (CMV) antigenemia was evaluated in 9 episodes of pneumonia which developed in 7 allogeneic marrow transplant patients between 9 and 495 days after transplant. The diagnosis of lung infiltration was made based on clinical findings including histological, cytological or microbiological examinations using bronchoalveolar lavage fluid specimens, sputum or lung tissue. The CMV antigen-positive leukocytes were detected with a direct immunoperoxidase technique using a peroxidase-labeled monoclonal antibody (HRP-C7) against CMV immediate early antigen. The episodes included 2 CMV pneumonias, 1 pneumocystis carinii pneumonia, 1 adenovirus pneumonia, 1 bacterial pneumonia, 1 bacterial and fungal pneumonia, 2 idiopathic pneumonias and 1 capillary leak syndrome associated with hyper acute GVHD. The CMV antigenemia became positive only in two patients with CMV pneumonia and the number of CMV antigen-positive leukocytes exceeded 10 per 50000 WBCs. The CMV antigenemia test required only 24 hours to obtain results. These observations suggest that the detection of CMV antigenemia is of great value in the differential diagnosis of pulmonary infiltrates in marrow transplant patients.
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PMID:[Cytomegalovirus antigenemia in the differential diagnosis of pulmonary infiltrates after allogeneic bone marrow transplantation]. 825 5

Intravenous immunoglobulins have a role also in the prevention of infections after a bone marrow transplantation. Even if a reduction of CMV pneumonia is reported it is not clear whether such an effect is due to a direct antiviral activity or it is mediated through an immune modulation that reduces GVHD and then the immune suppression. We are currently using i.v.Ig at a dose of 100 mg/kg/day within a protocol for GVHD prophylaxis after a mismatched BMT.
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PMID:[Intravenous immunoglobulins in bone marrow transplantation]. 826 52


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