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)

We report an 8-year-old boy who developed cough and respiratory failure 7 months after bone marrow transplantation (BMT) coinciding with the onset of chronic graft-versus-host disease (GVHD). Lung function data, imaging studies, lung biopsy and bronchoalveolar lavage were consistent with the diagnosis of bronchiolitis obliterans organizing pneumonia. While this has been reported in association with chronic graft-versus-host disease in one adult case previously, we report the simultaneous occurrence of BOOP and chronic GVHD in a child after bone marrow transplantation for the first time.
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PMID:Bronchiolitis obliterans organizing pneumonia and chronic graft-versus-host disease in a child after allogeneic bone marrow transplantation. 913 79

We identified eight patients with bronchiolitis obliterans (BO) in the autopsies of 81 bone marrow transplant (BMT) recipients. Rapidly progressive dyspnoea and cough were the main presenting symptoms in all eight patients, associated with overinflation and/or infiltrative opacity seen on chest X-ray and obstructive disorder revealed by pulmonary function tests. Early lesions were characterized by epithelial loss and an inflammatory infiltrate containing foamy histiocytes with mild luminal narrowing. Partial or total occlusion of the bronchiolar lumina by fibrous connective tissue was the feature of late lesions. Both changes were coexistent in all cases. In one case, small bronchi with cartilage were also affected by the obstructive process, showing bronchitis obliterans. All eight patients showed non-obstructive broncho-bronchiolitis characterized by denuding of respiratory epithelium, mural oedema and an inflammatory infiltrate in addition to BO, and these changes were also seen in 18 patients without BO. The submucosal glands of large bronchi and the trachea showed mucous retention and a mild inflammatory infiltrate in four of the eight patients. Coexistent infectious processes were seen in all cases, cytomegalovirus and Aspergillus being the most frequent organisms. BO probably develops as an immunopathological event related to graft-versus-host disease (GVHD) during the impaired immune status phase of the post-BMT period, possibly initiated by infection. Bronchial gland involvement in chronic GVHD is one of the factors responsible for this abnormal immune status.
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PMID:Broncho-bronchiolitis obliterans as a complication of bone marrow transplantation: a clinicopathological study of eight autopsy cases. Nagoya BMT Group. 936 65

Little is known about the profile of infection with Mycobacterium tuberculosis in bone marrow transplant (BMT) recipients. Of five BMT series with a total of more than 5,000 patients, only 10 cases of M. tuberculosis infection were described, with an overall incidence of 0.19%. We have conducted a prospective evaluation of 183 consecutive BMT recipients, and 10 patients were found to develop pulmonary tuberculosis post-BMT, yielding an incidence of 5.5%. We described the clinical features of these 10 patients, and analyzed the risk factors for development of tuberculosis using age- and sex-matched case control subjects who did not develop the disease. The median age of the 10 patients who developed tuberculosis was 29 yr (range, 17 to 40 yr). The median time for onset of symptoms was 150 d (range, 23 to 550 d), mainly presenting with fever and cough, with infiltrates on chest radiograph. Respiratory tract specimens, mostly sputum, yielded positive smears for acid-fast bacilli in three and positive M. tuberculosis culture in eight, whereas lung tissue histology was the first diagnostic test in two patients. Treatment with standard antituberculosis drugs for a longer duration was highly effective, with no excessive side effects. Risk factors identified for development of tuberculosis included allogeneic BMT (p < 0.05, relative risk [RR] = 23.7), total body irradiation (p < 0. 05, RR = 4.9), and chronic graft-versus-host disease (GVHD) (p < 0. 05, RR = 3.6). It is postulated that chronic GVHD predisposed to development of tuberculosis mainly via disruption of host reconstitution of immune defenses against M. tuberculosis.
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PMID:Risk factors for pulmonary tuberculosis in bone marrow transplant recipients. 976 78

We report two children who presented with cough and shortness of breath 7-8 months after a matched sibling stem cell transplant (SCT) for chronic myelogenous leukemia and myelodysplastic syndrome, respectively. Pulmonary function tests (PFTs) revealed severe airways obstruction (AO). However, radiographic investigations showed no serious abnormalities in the early phase and open lung biopsy revealed only mild lymphocytic bronchiolitis and bronchiolitis obliterans consistent with pulmonary graft-versus-host disease (GVHD). Despite administration of bronchodilators and various immunosuppressive agents obstructive lung disease progressed to pulmonary failure in patient 1, whereas stabilization of the clinical course was observed in patient 2. Serial PFTs were the best predictor of the clinical course in contrast to radiographic and histologic findings. It is concluded that PFTs should be performed repeatedly in pediatric patients after allogeneic SCT with the aim of diagnosing GVHD-associated AO in the subclinical phase. Progressive post-transplant AO necessitates prompt initiation of intensive immunosuppressive therapy in order to stop the underlying immunopathologic process even in the absence of severe radiographic and histologic findings.
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PMID:Discrepancy of clinical, radiographic and histopathologic findings in two children with chronic pulmonary graft-versus-host disease after HLA-identical sibling stem cell transplantation. 982 80

We report on a patient with chronic myelogenous leukemia who developed bronchiolitis obliterans organizing pneumonia (BOOP) after allogeneic bone marrow transplantation (BMT). A 19-year-old Japanese male complained of dry cough and dyspnea 7 months after BMT. The chest X-ray and computed tomography revealed patchy infiltrates bilaterally. Lung function test, lung biopsy and bronchoalveolar lavage were consistent with the diagnosis of BOOP. The patient also suffered from suspected graft-versus-host disease (GVHD) of the liver, after discontinuation of cyclosporine. Furthermore, prednisolone proved effective against the BOOP and the liver dysfunction. These findings indicate that BOOP is a possible pulmonary manifestation of chronic GVHD, and that immunological mechanisms may have effected the onset of BOOP after BMT in this case.
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PMID:Bronchiolitis obliterans organizing pneumonia (BOOP) with suspected liver graft-versus-host disease after allogeneic bone marrow transplantation. 1151 61

A 9-year-old boy with secondary chronic myelogenous leukemia after treatment of acute lymphoblastic leukemia underwent allogeneic bone marrow transplantation (BMT) from an HLA-identical sibling in December 1998. Grade II acute GVHD developed on day 24 and chronic GVHD developed 5 months after BMT. Cough and dyspnea appeared 9 months after BMT. Despite administration of tacrolimus and methylprednisolone (m-PSL) pulse therapy, the dyspnea gradually increased in severity. Bronchiolitis obliterans was diagnosed on the basis of lung biopsy in January 1999. Because renal dysfunction made it difficult to continue the use of tacrolimus, we attempted antithymocyte globulin (ATG) + m-PSL therapy. Major BCR/ABL mRNA was transiently positive on RT-PCR after the ATG + m-PSL therapy, but no severe complications were observed. A decreasing V50/V25 level and increasing peak flow value were observed in respiratory function tests after ATG + m-PSL therapy, and the patient is currently free of dyspnea. Our findings suggest that ATG + m-PSL therapy is beneficIal for patients with drug-resistant bronchiolitis obliterans after BMT.
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PMID:[Successful treatment with combined anti-thymocyte globulin and methylprednisolone for bronchiolitis obliterans after allogeneic bone marrow transplantation in a child with chronic myelogenous leukemia]. 1186 61

Pulmonary complications of hematopoietic stem cell transplantation (HSCT), including peripheral blood stem cell transplantation (PBSCT) and bone marrow transplantation, are frequent and often life-threatening. Differentiating acute infectious from noninfectious pulmonary complications is difficult but critical for proper treatment. The authors describe an 11-year-old boy who developed a sudden fever and cough associated with a normal chest radiograph 2 months after successful haploidentical PBSCT for severe aplastic anemia. High-resolution chest computed tomography revealed numerous tiny peripheral pulmonary nodules. Lung biopsy demonstrated an unusual occlusive thrombotic vascular lesion associated with hemorrhagic infarction without evidence of infection. The thrombi were composed of intensely basophilic granular material recently described as "cytolytic" thrombi. Symptoms and chest computed tomography improved rapidly following intravenous corticosteroids and cyclosporin. However, the patient subsequently died of rapidly progressive pulmonary hypertension. Our patient illustrates the importance of considering this noninfectious complication in the acute pulmonary disorders associated with HSCT as this condition may represent a pulmonary manifestation of acute graft-versus-host disease.
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PMID:Pulmonary cytolytic thrombi: unusual complication of hematopoietic stem cell transplantation. 1254 82

A 51-year-old female with acute myeloid leukemia was admitted to our hospital in December 2001. Though she had undergone two courses of induction chemotherapy (idarubicin hydrochloride + cytarabine), she failed to achieve a complete remission. In April 2002, while in non-complete remission, she subsequently underwent total body irradiation (TBI) and treatment with cyclophosphamide (CY) and etoposide (VP-16) before receiving an allogeneic peripheral blood stem cell transplant from her HLA-identical brother. For graft-versus-host disease (GVHD) prophylaxis, she was given tacrolimus and methotrexate. The infused CD34 positive cells provided 8.1 x 10(6) cells per kg. Engraftment was obtained on post-transplant day 14, and there was no evidence of clinical acute GVHD. The use of tacrolimus was discontinued on post-transplant day 60. As there was no occurrence of clinical acute GVHD, the patient received a donor lymphocyte infusion (CD3 cells 0.57 X 10(7) cells per kg) on post-transplant day 105. On day 132, however, she complained of coughing and fever, and on day 135, she was admitted to our hospital again for dyspnea. A CT scan demonstrated ground-glass opacity in the right pulmonary lobe. After considering her clinical course, symptoms, blood gas, CT scans, etc., we suspected interstitial pneumonia. The dyspnea progressively worsened, however, and despite the use of mechanical ventilation from day 143, the patient died on day 149. From the day she was admitted till the day she was intubated, she was unable to produce sputum. Autopsy findings revealed yellow-white tracheal pseudomembranes, as well as Aspergillus hyphae in the trachea, bronchus, and bilateral lungs. These findings are characteristic of Aspergillus tracheobronchitis. The clinical course of Aspergillus tracheobronchitis in allogeneic stem cell transplant recipients is, however, different from that of the usual invasive Aspergillus infection, and although Aspergillus tracheobronchitis is a very rare disease, attention should be paid to the possibility of its occurrence.
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PMID:[Acute myeloid leukemia with Aspergillus tracheobronchitis after allogeneic peripheral blood stem cell transplant]. 1551 Aug 28

Acute graft-versus-host disease is a common complication after allogeneic stem cell transplantation. It normally affects the skin, liver, and gut. We report a 54-year-old male who developed shortness of breath, cough, and bilateral pulmonary infiltrates in which the work-up failed to demonstrate an infectious etiology 165 days post-HLA-matched allogeneic peripheral blood stem cell transplant. Eighteen days before, his tacrolimus had been tapered and it was subtherapeutic on admission. A transbronchial biopsy showed a perivascular and interstitial lymphocytic infiltrate without evident pathogens on histology or extensive work-up. The clinical picture was suggestive of pulmonary acute graft-versus-host disease. No disease was present elsewhere. Accordingly, the patient was treated with steroids and tacrolimus. After 12 hr on methylprednisolone, his symptoms disappeared with eventual resolution radiologically. Acute graft-versus-host disease of the lung is a very uncommon complication after stem cell transplant, but it should be considered in patients who are at high risk for graft-versus-host disease or developing symptoms soon after discontinuing immunosuppression. Its diagnosis requires work-up to rule out an infectious etiology and a biopsy to confirm histology.
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PMID:Lymphocytic pneumonitis as the manifestation of acute graft-versus-host disease of the lung. 1592 16

Respiratory complications of bone marrow transplantation comprise the majority of its morbidity and mortality. Obstructive airways disease is the most common noninfectious respiratory complication, usually indicative of obliterative bronchiolitis (OB), which occurs in 9% of allogeneic marrow transplant patients. OB is rarely seen after autologous transplant because chronic graft versus host disease (GVH), the most commonly identified risk factor, does not occur in this setting. Alloreactive immunity is likely the cause, with donor type 2 T-helper (TH2) lymphocytes the primary mediators. OB presents at 6 to 12 months post-transplant with cough and dyspnea. Results of investigations include relatively normal or hyperinflated chest radiographs; thickened, dilated airways; and mosaic attenuation on high-resolution computed tomography (HRCT), and fixed airflow obstruction, hyperinflation, and gas trapping on physiological testing. Bronchoscopy and lavage are performed primarily to exclude infections. Transbronchial biopsy is often nondiagnostic, but because the clinical diagnosis is generally sufficient, surgical biopsy is not usually recommended. Histology reveals lymphocytic bronchiolitis, concentric bronchiolar fibrosis, and bronchiolar obliteration. Corticosteroids remain the mainstay of treatment, which is usually required for 3 to 9 months. Response is generally poor, with mortality between 40 and 100%, and lung function infrequently improves. Stabilization with permanent respiratory impairment is common. Early detection and prompt immunosuppression may improve outcomes.
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PMID:Obliterative bronchiolitis complicating bone marrow transplantation. 1608 71


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