Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018133 (graft-versus-host disease)
 18,032 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-three of 85 patients undergoing marrow transplantation between 1969 and 1973 developed interstitial pneumonia; 23 died. The clinical syndrome consisted of tachypnea, cough, fever, rales, and hypoxemia; the radiologic findings were variable. The development of interstitial pneumonia was significantly associated with graft-versus-host disease and allogenic grafting; patients with isogenic grafts were relatively spared. The increased attack rate between 1969-71 (20%) and 1972-73 (49%) was not fully explained by improved long-term survival, by an increased proportion of allogenic transplants, or by an increased incidence of graft-versus-host disease. Intranuclear inclusions typical of cytomegalovirus were identified in 9 of 17 autopsy-confirmed cases, and patients whose marrow donors had positive cytomegalovirus antibody titers developed interstitial pneumonia more often than patients whose donor had negative titers. Interstitial pneumonia is an important cause of morbidity and mortality after human marrow transplantation. No effective treatment is presently available.
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PMID:Cytomegalovirus pneumonia after human marrow transplantation. 23 6

A 19-year-old woman with extensive, persistent chronic graft versus host disease (GVHD), following an HLA-identical bone marrow graft for acute leukemia, developed rapidly progressive airflow obstruction 140 days post-transplantation (PT) and presented clinically with persistent cough, inspiratory rales, bronchospasm and exertional dyspnea. Pulmonary function tests (PFT) showed rapidly evolving severe airflow obstruction and hypoxemia without restrictive ventilatory defect. Open lung biopsy on the 204th day PT confirmed focal bronchiolitis obliterans. On the 381st day PT, she remained clinically stable. Chest x-ray film showed mild overinflation, but was otherwise unremarkable. PFT's continued to show very severe airflow obstruction without restrictive ventilatory defect. The etiology of the obliterative bronchiolitis might be explained on the basis of a direct immunologic reaction mediated by GVHD or possibly a joint viral-GVHD interaction. Awareness and further detailed documentation and analysis of this unusual respiratory syndrome associated with marrow transplant recipients may help clarify the role of GVHD in the development of lung disease in recipients of marrow grafts.
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PMID:Bronchiolitis obliterans complicating bone marrow transplantation. 388 42