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 a case of myeloid/NK cell precursor acute leukemia, which was successfully treated with allogeneic peripheral blood stem cell transplantation (allo PBSCT). A 31-year-old woman was admitted to our hospital with general fatigue, anorexia and leukocytosis. Bone marrow aspiration showed infiltration of many atypical blasts. She was diagnosed as having myeloid/NK cell precursor acute leukemia by morphological and immunohistochemical analysis. Complete remission was achieved by induction chemotherapy, but as myeloid/NK cell precursor acute leukemia is reported to have an extremely poor prognosis due to frequent relapse, the patient underwent allo PBSCT from her HLA-identical father, together with a myeloablative conditioning regimen. She suffered several transplantation-related complications including acute graft versus host disease (grade II) and ischemic enterocolitis associated with thrombotic microangiopathy, but these were overcome by supportive therapy. She was discharged on day 168 after allo PBSCT, and so far there has been no evidence of relapse during a follow-up period of 15 months.
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PMID:[Successful treatment of myeloid/natural killer cell precursor acute leukemia with allogeneic peripheral blood stem cell transplantation]. 1192 73

It has been reported that autoimmunity might be sometimes transferred from a donor to a recipient following allogenic bone marrow transplantation (allo-BMT). We report a patient to whom Basedow disease was transferred from the donor through an allo-BMT. A 18-year-old man with acute lymphoblastic leukemia, received the allo-BMT from his HLA-identical sister. Two-years later, he developed symptoms of palpitations and general fatigue. He was diagnosed as having Basedow disease because of hyperthyroidism, and high levels of the anti-thyroid stimulating hormone receptor antibody and antithyroid antibody. When he received the allo-BMT, his donor had neither the clinical symptoms of Basedow disease, nor abnormal findings on examination to determine her eligibility as a the donor. We retrospectively assayed anti-thyroid antibodies from their cryopreserved sera, and found the donor's anti-thyroid antibody was positive, while her serum was negative before transplantation. It was apparent that the donor had subclinical Basedow disease. The patient has remained in complete remission without any signs of chronic graft-versus-host disease (GVHD) up till the time of writing. It is believed that an anti-thyroid tissue reactive B-cell clone was transferred from the donor to the patient and commenced to produce antibodies. It is suggested that thorough investigation of the donor's autoimmunity is needed before allo-BMT. If the recipient develops an autoimmune disease after allo-BMT, we should definitely investigate the donor's autoimmunity.
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PMID:[Basedow disease occurring after allogeneic bone marrow transplantation for acute lymphoblastic leukemia]. 1241 87

Thalidomide is being increasingly used after stem cell transplantation as immunosuppression for patients with chronic graft-versus-host disease, as well as for antiangiogenesis effects in patients with multiple myeloma, brain tumors, leukemia, or other malignancies. The goal of this study was to determine if thalidomide improved the quality of life by virtue of its associated sleep-promoting, anxiety-reducing, antiwasting, and antidiarrheal effects. We therefore studied 28 patients with resistant chronic graft-versus-host disease who were treated with thalidomide (13 patients) or other immunosuppressive drugs (15) and compared them with healthy control subjects (16). All patients completed quality-of-life questionnaires prospectively before beginning regimens of thalidomide or other immunosuppressive drugs and completed similar questionnaires at 3- and 6-month intervals thereafter. The Transplant Symptom Frequency score was similar for healthy control subjects and both groups of patients with chronic graft-versus-host disease, regardless of whether they had received thalidomide or not. Quality of sleep was equally poor in patients who received or did not receive thalidomide. The most common complaint of patients with chronic graft-versus-host disease was fatigue, followed in frequency by overeating. The control group had similar concerns. This pilot study suggests that patients with chronic graft-versus-host disease have a quality of life similar to that of their health care workers, regardless of whether they are treated with thalidomide or other immunosuppressive drug, and that fatigue and overeating are the most common complaints.
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PMID:Thalidomide in chronic graft-versus-host disease after stem cell transplantation: effects on quality of life. 1246 2

Allogeneic transplantation of hematopoietic stem cells has potential for cure high risk malignant hematopoietic disorders. Advances in patients' supportive care and in graft versus host disease (GVHD) prevention have improved patient outcome. Although late relapses can occur, they are rare beyond 2 years after transplantation. However a prolonged follow-up is essential because of the risk of long-term complications. Some of them are life threatening (infections, secondary malignancy, chronic GVHD), others affect patient quality of life (chronic GVHD, cataract, osteonecrosis, sterility.). Fatigue, sleep disturbances and sexual dysfunction are the most common transplant related side effects and can also significantly impair patient quality of life. Despite these complications, most patients describe their quality of life as good, and consider that the benefit of the transplantation outweight its late effects.
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PMID:[Bone marrow transplantation for leukemia: long term outcome]. 1295 1

A 31-year-old woman with acute myeloblastic leukemia (AML) underwent allogeneic peripheral blood stem cell transplant (PBSCT). On day +274 following transplantation, the patient had severe chest pain, high-grade fever, and general fatigue. Electrocardiographic examination revealed ST segment elevation, and echocardiographic examination revealed an obvious pericardial. The diagnosis of pericarditis was made. We could not exclude the possibility of a combination of chronic GVHD involving the liver, because biochemistry examination revealed altered liver dysfunction, but liver biopsy was not performed. The patient underwent empirical treatment for bacterial or viral infection, and was given prednisolone for chronic GVHD. Retrospective serologic examination revealed that EBV reactivation had occurred at this time. This is the first reported case of pericarditis associated with EBV reactivation after allogeneic-stem cell transplantation (allo-SCT).
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PMID:Pericarditis associated with Epstein-Barr virus reactivation in a patient following allogeneic peripheral blood stem cell transplantation from an HLA genotypic 1-locus mismatched sibling donor. 1510 30

A 44-year-old man was referred to Hakodate Chuo Hospital because of progressive fatigue in April 2001, and was diagnosed as having adult T-cell leukemia (ATL; acute type). Complete remission was not obtained even with the application of multiple anti-leukemic agents including CHOP-V-MMV. The patient received an allogeneic bone marrow transplant from his HLA-identical, HTLV-I antibody-negative sibling donor in June 2002. The conditioning regimen consisted of cyclophosphamide, etoposide and total body irradiation. Cyclosporine A and a short course of methotrexate were given as prophylaxis for graft-versus-host disease (GVHD). Engraftment was achieved on day 16, while ATL cells were detected in the peripheral blood throughout the transplantation. ATL cells were also detected in bone marrow on day 20. Withdrawal of the immunosuppressant induced the eradication of the residual ATL cells in the peripheral blood on day 24 and in the bone marrow on day 40. Grade III of acute GVHD developed in the bowel on day 40, which lasted for over 5 months and was gradually resolved by administration of prednisolone and tacrolimus. The patient remains in complete remission 23 months after the transplantation. The clinical consequence of our case clearly shows that a graft-versus-leukemia (GVL) effect combined with graft-versus-host disease (GVHD) plays a curative role even in an early phase after bone marrow transplantation for patients with adult T-cell leukemia.
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PMID:[Eradication of adult T-cell leukemia cells and maintenance of remission by the graft-versus-leukemia effect after allogeneic bone marrow transplantation]. 1551 Aug 33

We investigated efficacy and toxicity of lenalidomide in 24 heavily pretreated myeloma patients with a median age of 59 years (range: 37-70) and relapse after allo-SCT. Lenalidomide was given at a dose of 15 mg (n=4), or 25 mg (n=20), orally once daily on day 1 to day 1 every 28 days, with (n=20) or without (n=4) DHAP. The median number of lenalidomide cycles was five (range: 2-17). Major side effects were leukopenia (grade 4: 4%, grade 3: 21% and grade 2: 17%) and thrombocytopenia (grade 3: 17% and grade 2: 29%); infectious complications were observed in 50%. Non-hematological toxicity consisted of muscle cramps (n=9), fatigue (n=5) and constipation (n=2). Mild grade I-II GVHD was seen in three patients. Response was achieved in 66%: CR in 8%, VGPR in 8%, PR in 50% and SD in 13%. The median time to progression was 9.7 months (95% confidence interval (CI): 7.5-11.9), and median OS was 19.9 months (95% CI: 17.3-22.5). Immunomonitoring after lenalidomide showed significant increase of activated NK (NKp44(+)) and T (HLA-DR(+)) cells, as well as regulatory T cells (CD4(+), CD25(+), CD127(lo)), supporting an immunomodulating anti-myeloma effect of lenalidomide.
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PMID:Lenalidomide as salvage therapy after allo-SCT for multiple myeloma is effective and leads to an increase of activated NK (NKp44(+)) and T (HLA-DR(+)) cells. 1958 25

A 35-year-old male with a FLT3(+) AML underwent allogeneic peripheral blood stem cell transplant using a myeloablative non-total body irradiation (TBI) conditioning regimen from his HLA-matched sibling donor. Following transplantation, he developed grade II acute graft-versus-host disease (GVHD) that resolved with increasing immunosuppression. The medications were subsequently discontinued, and he did not develop any evidence of chronic GVHD. Eighteen months after transplant, while off all immunosuppression, he developed fatigue and a blood count showed circulating blasts consistent with relapse of his disease. Among the various therapeutic questions is whether there is a role for a second allogeneic transplant to treat his disease and if so, at what time, with what conditioning, and with which type of donor.
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PMID:ASH evidence-based guidelines: is there a role for second allogeneic transplant after relapse? 2000 27

Toxicity-reduced conditioning is a curative treatment option for medically compromised or elderly patients ineligible for myeloablative hematopoietic cell transplantation (HCT). The aim of this study was to detect prognostic factors for overall survival (OS) and to evaluate quality of life (QOL) in a large homogeneous cohort of 160 consecutive patients aged > or =60 years treated with allogeneic HCT. We evaluated age, sex, performance status, comorbidities, pulmonary function, lactic dehydrogenase concentration, type of donor, disease status, CD34(+) cells transplanted, cytomegalovirus status, time from diagnosis to HCT, and the development of acute and chronic graft-versus-host disease (GVHD). All patients who survived for > or =6 months (n = 79) were asked to complete a QOL survey. All patients (median age, 64.7 years; range, 60.1-76 years) received pretransplantation conditioning with fludarabine, BCNU, and melphalan. With a median follow-up of 35 months, the 1-year OS was 62.4% and 3-year OS was 47.4%. Multivariate analysis revealed compromised performance status as the most significant negative prognostic parameter for OS (P < .003), whereas male donor (P = .008) and chronic GVHD (P = .024) were associated with better OS. The 89% of survivors who returned the QOL questionnaire rated their global QOL as good-to-excellent despite impaired functional capabilities and such symptoms as fatigue, dyspnea, and loss of appetite. The main prognostic factor was performance status, not age. Our data suggest that toxicity-reduced conditioning offers a chance for enhanced OS with an adequate QOL.
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PMID:Prognostic factor and quality of life analysis in 160 patients aged > or =60 years with hematologic neoplasias treated with allogeneic hematopoietic cell transplantation. 2014 20

We present a case of concurrent diagnosis of acute myeloid leukemia (AML) with multiple myeloma with complex karyotype, which was successfully treated with allogeneic stem cell transplantation. A 51-year-old man with no past medical history presented with fatigue and anemia with blasts on peripheral smear. Bone marrow biopsy confirmed the simultaneous diagnosis of myeloma and AML. The patient received bortezomib and the myeloma responded well, but induction chemotherapy for the AML failed twice. He underwent an allogeneic stem cell transplant from his human lymphocyte antigen (HLA)-matched sibling, and is now disease-free approximately one year since the transplant. He has mild graft-versus-host disease (GVHD). To our knowledge, this is the first case of a patient with simultaneous AML and multiple myeloma who has undergone successful treatment with allogeneic stem cell transplantation.
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PMID:Simultaneous acute myeloid leukemia and multiple myeloma successfully treated with allogeneic stem cell transplantation. 2103 23


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