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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)

A female patient with severe idiopathic aplastic anaemia received a successful bone-marrow transplant from her HLA-identical, mixed-lymphocyte-culture-compatible, brother. 8 months after transplantation she had localised cutaneous measles. Chronic sclerodermatous changes developed which were indistinguishable from chronic graft-versus-host disease and were limited to the areas of the original exanthem. Interaction between viral infection and minor histocompatibility differences probably resulted in graft-versus-host disease in this patient.
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PMID:Sclerodermatous graft-versus-host disease limited to an area of measles exanthem. 7 22

Cytomegalovirus infection in compromised hosts occurs most frequently as asymptomatic shedding of a reactivated virus. Reactivation occurs when cellular immunity is compromised owing to either immune-deficiency disease or iatrogenic intervention. When intervention is modest, most antibody-positive patients do not shed virus (19); when the group is treated with a higher mean dose of cytotoxic agents, almost all antibody-positive patients shed virus (6). In the instance where the chemotherapeutic program includes massive doses of these agents, as in heart or marrow transplantation, or when dysfunction of all cellular activity is extreme, as in the case of severe combined immune deficiency and far-advanced neoplasia, dissemination of infection with multiple-organ involvement ensues (17, 20-22). Primary infection may occur in some patients with neoplasia or in marrow-transplant recipients from either blood transfusions or from marrow, although data are insufficient to be certain (22). It has been conclusively shown, however, that seronegative renal-allograft recipients usually develop primary infection when they acquire a kidney from a seropositive donor. Clinical illness related to virus infection in the first few months after transplantation occurs in almost all patients with primary infection and seldom in those with reactivation infection (6, 25, 26). Three very intriguing observations have been made that should suggest avenues for future research: (a) Since illness occurs more closely related to development of antibody than it does to onset of virus shedding, this suggests that host response plays an important role in the disease that is obviously caused by a virus; a definition of the mechanism of this interaction could lead to an understanding of host-induced disease processes in man; (b) Graft-versus-host disease in marrow transplantation; and (c) allograft rejection in renal-graft recipients correlate with development of CMV infection (16, 22, 24, 26). Taken together, these observations are consistent with the hypothesis that virus antigens interrelate with most antigens in such a way as to lead to immune response to both antigens. Exploration of this clinical observation could lead to a greater understanding of the function of the HL-A system in man.
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PMID:Cytomegalovirus (CMV) in the compromised host(s). 19 29

HCMV infection diagnosed by the highly sensitive polymerase chain reaction (PCR) technology in blood, urine and skin biopsies of patients after bone marrow transplantation (BMT) correlated with the reconstitution of peripheral blood lymphocytes and dermal immunohistological alterations to evaluate the interaction of viral infection with the recovery of the immune system, as well as with the induction or aggravation of graft-versus-host disease (GVHD). In a prospective study 73% of 63 patients showed viremia at a median time of 25 days after BMT. Only 44% of these cases that also presented with a higher frequency of acute GVHD symptoms developed HCMB disease later on. In the skin, similar immunohistological alternations, as well as frequent primary local HCMV infection before the development of cutaneous signs of GVHD, was found, suggesting the direct involvement of anti-HCMV immune responses in the induction of GVHD-associated organ lesions.
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PMID:Influence of human cytomegalovirus on immune reconstitution after bone marrow transplantation. 132 85

An allogenic bone marrow transplantation (BMT) in an acute nonlymphocytic leukemia (ANLL) patient with post-transfusion hepatitis C is presented. A 13-year-old girl was admitted to our hospital on May 1988, and diagnosed as having ANLL M2 according to the FAB classification. During the induction and post-induction chemotherapy, 116 units of blood products were transfused to her as the supportive therapy until October 1988, when non-A non-B hepatitis developed. As the persistent liver dysfunction interfered with anti-leukemic chemotherapy on the protocol, allogeneic BMT from her HLA identical MLR nonreactive brother was done on July 1989. Preconditioning regimen consisted of busulfan and cyclophosphamide. GVHD prophylaxis consisted of cyclosporine A and short term methotrexate. After the BMT, her liver dysfunction once improved; her serum amino-transferase levels were normal for about 3 months. Soon after discontinuation of cyclosporine A, however, her liver function deteriorated again. The examination of hepatitis C virus antibody in her sera, which had been harvested sequentially and stored at -40 degrees C, on November 1989 revealed that she had been already seropositive at the time of BMT. The BMT-induced immunologic changes may have influenced the natural course of hepatitis C virus infection in the patient.
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PMID:[Bone marrow transplantation in a pediatric case of acute nonlymphocytic leukemia with hepatitis C]. 171 55

Graft-versus-host disease (GVHD) in leukemia patients following allogeneic bone marrow transplantation (BMT) has a lot of demerits but it also has a merit, namely graft-versus-leukemia effect. We reported the results of our recent trials on prevention, treatment and induction of GVHD, and prevention of viral infection after BMT. The results were as follows: 1) Twenty-four percent of patients who received prophylactic administration of cyclosporine and short term methotrexate still developed II degree-IV degree acute GVHD. 2) Patients with I degree or II degree acute GVHD showed good clinical courses. But, most patients with III degree GVHD gradually developed chronic GVHD. All patients with IV degree GVHD died of GVHD or infection. 3) Mizoribine and deoxyspergualin were effective for steroid-resistant GVHD. 4) Bestatin was administered to recipients who did not develop GVHD until day 30 after BMT. An interim report suggests that bestatin may induce chronic GVHD and suppress the relapse of leukemia. 5) Oral administration of gamma-globulin may prevent viral enteritis. Intravenous administration of anti-cytomegalovirus monoclonal antibody may prevent cytomegalovirus pneumonia.
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PMID:[Control of graft-versus-host disease and infection associated with immunosuppression]. 190 15

Using in-situ hybridizaiton, we showed the presence of the Epstein-Barr (EB) virus genome in epidermal cells from a patient with chronic lymphocytic leukemia and unusual cutaneous lesions characterized clinically by a maculopapular eruption and histologically by epidermal cell degeneration and lymphoid cell infiltration. Such histologic changes are similar to those seen in graft-versus-host disease. The EB virus genome was mainly detected in the basal, germinative cells of the abnormal epithelium. Specimens of our patient's healthy skin were negative. The presence of EB virus DNA in skin lesions was confirmed by polymerase chain reaction adapted for analysis of paraffin-embedded tissue. These findings indicate that EB virus can infect the human epidermis and that the viral infection may produce a distinctive cutaneous disease.
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PMID:Detection of Epstein-Barr virus in epidermal skin lesions of an immunocompromised patient. 215 77

Three patients with acute myeloblastic leukemia, thalassemia major and aplastic anemia experienced hemorrhagic cystitis on the 23rd, 35th and 36th day respectively after allogeneic bone marrow transplantation. The conditioning regimens before transplantation comprised cyclophosphamide with or without busulfan and total lymphoid irradiation. The hematuria lasted from 5 to 45 days and then subsided after treatment. Multiple factors including the toxicity of chemotherapeutic agents, viral infection and graft-versus-host reactions may contribute to late onset hemorrhagic cystitis after allogeneic bone marrow transplantation. Adequate treatment to minimize urothelial damage from chemotherapy, screening for viral infection and controlling graft-versus-host disease are mandatory in decreasing the complication of late-onset hemorrhagic cystitis after bone marrow transplantation.
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PMID:Late onset hemorrhagic cystitis after allogeneic bone marrow transplantation. 255 95

Before treatment of 181 patients with bone marrow transplantation (BMT) for leukemia, severe aplastic anemia, or metabolic disorders, the oral condition was examined clinically and roentgenologically. Fifty-three patients (29%) had chronic dental infections (osteitis) that needed treatment before BMT. In 10 of 181 cases (6%), BMT was postponed because of oral infections. Septicemia during the neutropenic phase was caused by oral microorganisms (alpha streptococci) in 24 of 59 (41%) patients with microbiologically proven septicemia. Septicemia with alpha streptococci was associated with graft-versus-host disease prophylaxis with methotrexate and subsequent increased frequency of oral ulcerations. No difference was observed in the frequency of reactivation of latent herpes simplex virus infection between different graft-versus-host disease prophylaxis regimens. Reactivation was more frequent in patients conditioned with total body irradiation than in patients conditioned without total body irradiation. Antiviral prophylaxis, with subsequent decreased frequency of oral herpes simplex reactivation, appeared to contribute to a low frequency of septicemia with alpha streptococci.
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PMID:The oral cavity as a port of entry for early infections in patients treated with bone marrow transplantation. 259 18

Oral mucous membrane lesions were studied in 54 children below 12 yr of age treated with allogeneic bone marrow transplantation mainly because of hematological malignancies. Sixty-two percent of the children exhibited a wide range of oral side effects during therapy. Lesions observed during the first 2 wk prior to engraftment of the donor marrow were related to the chemo- and radiotherapy given. Oral ulcerations were seen in 34% of the children. Children given methotrexate as graft-versus-host disease (GVHD) prophylaxis exhibited oral ulcerations significantly (P less than 0.05) more often than those given cyclosporin. Oral lesions related to acute GVHD were only observed in two patients. Reactivating herpes simplex virus infection was seen in 35% of the children who were seropositive prior to BMT. An extensive oral candidiasis was observed in 15% of the patients. All six children with a chronic GVHD exhibited changes in the oral mucosa 2-4 yr after transplantation such as erythma of the mucous membranes, tongue atrophy and also lichenoid changes in the buccal mucosa.
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PMID:Oral mucous membrane lesions in children treated with bone marrow transplantation. 266 86

The effect of two conditioning regimens given prior to allogeneic bone marrow transplantation (BMT) on the kinetics of engraftment were compared. 5 patients received busulfan and cyclophosphamide: 7 patients received daunorubicin, vincristine, cytosine arabinoside, methylprednisone and VM-26 plus total body irradiation (TBI). Bone marrow progenitors (BFU-E, CFU-E, CFU-GM, CFU-F) were assayed up to 3 months post-BMT. All progenitors were severely depressed in spite of peripheral blood recovery. There was no stromal recovery in any adult patient post-BMT. There was no significant difference in time to engraftment, or colony forming units, or between patients conditioned with chemotherapy alone or chemotherapy plus TBI. We were unable to detect effects of graft-versus-host disease or cytomegalic viral infection on bone marrow progenitors or peripheral blood recovery in this study.
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PMID:A comparison between regimens containing chemotherapy alone (busulfan and cyclophosphamide) and chemotherapy (V. RAPID) plus total body irradiation on marrow engraftment following allogeneic bone marrow transplantation. 268 82


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