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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)

Acute graft-versus-host disease, interstitial pneumonitis, endothelial leakage syndrome, and veno-occlusive disease are major complications of bone marrow transplantation. Though several new regimens for prophylaxis and treatment of these syndromes have been introduced, the overall incidence has been only slightly reduced over the last few years. We retrospectively analyzed tumor necrosis factor alpha (TNF alpha) serum levels between day -8 and day 100 after bone marrow transplantation in 56 patients transplanted in our unit for a variety of hematological diseases. In 34 patients with uneventful courses, mean TNF alpha levels rose to a maximum of 76 +/- 29 pg/mL. In contrast, 22 patients with major transplant related complications showed mean increases of TNF alpha of 492 +/- 235 pg/mL (P less than .0001). Increases of TNF alpha occurred before interstitial pneumonitis and severe acute graft-versus-host disease with a latency of 25 to 54 days. Early complications such as endothelial leakage syndrome and veno-occlusive disease were closely associated with increases of TNF alpha serum levels. Our study suggests two pathways of TNF alpha release: activation of host macrophages and stimulation of donor cells in the course of acute graft-versus-host disease. Cytokine monitoring should be helpful for prediction and earlier treatment of major transplant related complications.
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PMID:Increased serum levels of tumor necrosis factor alpha precede major complications of bone marrow transplantation. 226 57

One hundred and four patients with acute leukemia treated by allogeneic bone marrow transplantation in Japan were analysed for the incidence of interstitial pneumonitis (IP). Thirty-six (35%) of 104 marrow graft recipients developed IP. Cytomegalovirus (CMV) was the most frequent organism (61%). Using multivariate analysis, remission at transplant (P = 0.0001) and use of cyclosporin A to prevent graft-versus-host disease (P = 0.0363) were found to be significant factors associated with a decreased incidence of IP. For preventing IP, anti-CMV hyperimmune globulin was effective, while interferon and acyclovir were not.
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PMID:Interstitial pneumonitis in allogeneic bone marrow transplantation: a report from the Japanese BMT Study Group. 245 86

The lymphocyte cell surface molecule CD5 (T1, Leu 1, Tp67 in the human; Ly 1 in the mouse) is expressed on the majority of circulating T lymphocytes and a small population of B cells. We have analyzed CD5 expression on repopulating T cells in the peripheral blood of patients after allogeneic bone marrow transplantation (BMT). The frequency of CD3+ T cells that lack expression of CD5 is dramatically increased after BMT compared with the normal population. The percent of total CD3+ CD5- cells correlated with the presence of graft versus host disease and with time following transplant, but did not correlate with age, diagnosis, preparative regimen, T-cell depletion of the marrow, major histocompatibility complex compatibility, or the presence or absence of interstitial pneumonitis. Furthermore, the total number and percent of CD8+ CD5- cells was increased following BMT. CD3+ cells from BMT patients were sorted for the presence or absence of CD5 expression. CD3+ CD5- cells were capable of interleukin-2 production and of mediating cytolysis following lectin stimulation. We conclude that CD3+ CD5- T cells are functional and represent a significant proportion of circulating cells in patients after BMT.
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PMID:A large proportion of T lymphocytes lack CD5 expression after bone marrow transplantation. 246 8

In acute leukaemias there was a stable plateau in the survival curve at 45% after two years if grafted in first complete remission (n = 20) but only 13% of the patients are disease-free alive if grafted in a more advanced stage of the disease (n = 8). In 16 patients transplanted for chronic myeloid leukaemia the overall survival is 40%, in cases with graft-versus-host disease (GVHD) prevention by cyclosporine survival rate could be improved. Only 8 patients with severe aplastic anaemia, partially in low performance status were able to be transplanted; three died of infections, another by acute GVHD. The fatal complications in our study characterize the international well-known major problems in BMT: GVHD, interstitial pneumonitis, infections, graft failure in aplastic anaemia and recurrence of leukaemia, especially in more advanced leukaemia stage.
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PMID:Allogeneic bone marrow transplantation for leukaemia and aplastic anaemia. Results of the Leipzig BMT Group. 248 Feb 78

At the end of the sixties and to beginning of the seventies years the total body irradiation (TBI) was introduced in the concept of bone marrow transplantation (BMT). The aim is the destruction of leukaemic or normal stem cells surviving the chemotherapy or the overcoming of the immunological defense. From March 1980 to January 1987 we have treated 84 patients with single exposure of 8.5 to 10.5 Gy midline dose for body and lung in cases of leukaemia and of 6 to 7 Gy for patients with aplastic anaemia. We used a dose rate of about 5.5 cGy/min delivered by a linear accelerator. The results were comparable with other centres but a further indicator for the effectiveness of a irradiation technique is also the idiopathic interstitial pneumonitis (IIP). Our incidence of IIP was 10.7 per cent and the mortality was 2.4 per cent. Additional we have had 8.3 per cent interstitial pneumonitis (IP) caused by an infection. All patients with a combination of IP and GVHD had a fatal prognosis. In present time a tendency is to see to fractionation techniques in total body irradiation for decreasing of the pneumonitis rate, the reduction of severe acute and delayed side effects, for a better homogenisation of the dose in the whole body and for using of synchronizing effects on the stem cells.
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PMID:Fundamentals, trends and our experiences with total body irradiation (TBI) before bone marrow transplantation (BMT). 248 Feb 94

Utilization of bone marrow transplantation as a therapeutic modality continues to increase. More and more institutions are initiating bone marrow transplant programs. During the 33-year period between 1955 and 1987, more than 20,000 patients received allogeneic bone marrow transplants; more than 50% of these were performed in the 3 years, 1985-1987. Transplantation is an effective therapy for acute leukemia; in some instances it is the preferred treatment. In chronic myelogenous leukemia, severe aplastic anemia, and some genetic and immune deficiency diseases, bone marrow transplantation provides the only possibility for cure. Bone marrow transplantation is associated with serious problems such as graft-versus-host disease (GvHD), graft failure, interstitial pneumonitis and, until recently, the requirement for an HLA-identical sibling donor. In the past few years, an increasing number of transplants have been performed using HLA-partially matched related or unrelated donors with some success, the level of which is yet to be determined. The development of acute GvHD (8) and interstitial pneumonitis (9, 10) can often be predicted by risk factor assessment. Special precautions can then be taken for patients at high risk of these complications. In this report, current data from the International Bone Marrow Transplant Registry were summarized and several risk factors affecting outcome were identified.
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PMID:Current status of bone marrow transplantation. 248 30

Results of the bone marrow transplantation (BMT) for 120 cases of leukemia, which were done in nine institutes in Nagoya (Nagoya Bone Marrow Transplantation Group) last ten years, were analyzed to determine the factors associated with an increased risk of developing interstitial pneumonia (IP). IP developed 49 out of 120 patients (49.8%) and case fatality rate was 63.3%. The median time from transplantation to onset of IP was 81 days (range 13-575 days), in 30 out of 49 cases (61.2%), this complication developed within 100 days after transplantation. Of the 49 patients who developed IP, cytomegalovirus (CMV) infection was associated in 18 cases (36.7%), no cases of P. carinii infection was detected. Five factors were associated with an increased risk for developing IP, (1) older age (greater than or equal to 47.0%: less than 10 y. 10.0%) (p less than 0.01) (2) disease stage at BMT (non-remission 76.2%: remission 32.5%) (p less than 0.01) (3) presence of acute GVHD ((+) 52.5% (-) 28.8%) (p less than 0.05) (4) onset day after BMT (less than or equal to 100 days 61.2%: greater than 100 d. 38.8%) (p less than 0.01) (5) sex matching between donor and patient (sex match 28.8%: sex mismatch 57.1%) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Interstitial pneumonia (IP) in bone marrow transplantation in leukemia--120 cases analysis in Nagoya Bone Marrow Transplantation Group]. 255 32

A 15-year-old girl suffering from acute lymphoblastic leukemia developed cytomegalovirus interstitial pneumonitis 34 days after an allogenic bone marrow transplantation. The disease was diagnosed by open lung biopsy. Histopathologic examination disclosed intranuclear and intracytoplasmic inclusion bodies, as well as, a positive cytomegalovirus antigen detected by an immunofluorescence stain using a cytomegalovirus monoclonal antibody. The virus culture also eventually produced cytomegalovirus. Because of the lack of ganciclovir in this country, antiviral therapy of a non-specific nature was given to this patient. However, the treatment was ineffective and she subsequently died. There is an association between the immunologic events of a graft-versus-host disease and the development of cytomegalovirus interstitial pneumonitis. The pathogenesis of cytomegalovirus interstitial pneumonitis in a bone marrow transplant recipient is evidence of an immunopathologic disease, rather than that of a purely infectionus disease. years, the treatment modality of cytomegalovirus interstitial pneumonitis in bone marrow transplant recipients has become a combination of specific antiviral and immune therapy.
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PMID:Cytomegalovirus interstitial pneumonitis in a bone marrow transplant recipient. 256 66

The probability of long term survival for allogeneic graft patients was 63% for ALL, 64% for ANL and 40% for CML in the 1st remission or 1st chronic phase of each leukemia. The major causes of death were interstitial pneumonia, relapse of leukemia and infections. On relationship of GVHD and the long term survival, the probability of 5 years survival was 38%, 47% and 25% in grade O, I and II-IV of acute GVHD respectively. And the relationship between the relapse rate and GVHD, the patients with both of acute and chronic GVHD showed the lowest relapse rate 15.9%, the patients without GVHD showed the highest relapse rate 37.8% and the patients with either of GVHD showed the rate of between those of two groups. This may suggest that GVHD both acute and chronic might have an ability that can suppress the relapse of leukemia, i.e. GVL reaction. Interstitial pneumonia occurred in 32% of allograft patients and was often lethal complication (53%). Among many of prophylaxis tested, the followings were effective, a lower dose rate of total body irradiation, the selection of CMV-seronegative platelets donor, and the prophylactic administration of anti-CMV high titer globulin. Colony stimulating factor of human urine was also effective for shortening the granulopenic period after transplantation to prevent severe infections.
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PMID:[Allogeneic bone marrow transplantation]. 260 Oct 39

Twenty-one patients with Philadelphia chromosome-positive chronic myelogenous leukemia (CML) in advanced phases were treated with piperazinedione (PIP), total body irradiation (TBI) and allogeneic bone marrow transplantation. Eleven were in blastic transformation, five were in accelerated phase, and five were in second chronic phase. The median age was 29 years (range, 13-41 years); there were 14 males. All patients but one were rendered aplastic by this regimen. Of these, 17 had hematologic engraftment, recovering granulocytes to 1.0 x 10(9)/l in a median of 28 days (range, 11-52 days). Three patients failed to engraft. Of those who engrafted, five relapsed and died of disease, one relapsed and died of a polymicrobial wound infection, nine patients died of treatment-related complications, including graft-versus-host disease, interstitial pneumonitis and sepsis, and one patient developed large-cell lymphoma 27 months after transplant and died of this 18 months later. One patient relapsed after 31 months died of polymicrobial sepsis at 37 months, and one patient remains disease-free at 54+ months. The 3-year survival rate was 14%. Survival at 1 year was related to having a spleen that did not extend beyond 2 cm below the left costal margin at the time of transplantation, and those with a large spleen at initial presentation relapsed more often. PIP-TBI with allogeneic bone marrow transplantation can induce durable remissions in a small proportion of patients in advanced phases of CML, but it is not superior to cyclophosphamide-TBI in this patient group.
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PMID:Piperazinedione plus total body irradiation: an alternative preparative regimen for allogeneic bone marrow transplantation in advanced phases of chronic myelogenous leukemia. 264 72


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