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)

Visceral disseminated varicella-zoster virus (VZV) infection occurred with acute graft-versus-host disease in a 33-year-old Japanese male with non-Hodgkin lymphoma who had undergone allogeneic stem cell transplantation from an HLA-identical sibling after reduced intensity conditioning chemotherapy. Although ganciclovir and acyclovir treatment was effective temporarily, the number of VZV-DNA copies in the blood remained at a high level, and the hepatitis was prolonged. The patient was treated with foscarnet, which led to improvement of the VZV viremia and the hepatic dysfunction. Foscarnet therapy should be considered for acyclovir-resistant VZV infection in the setting of allogeneic hematopoietic stem cell transplantation.
 ...
PMID:[Successful treatment with foscarnet for disseminated varicella-zoster infection after reduced intensity stem cell transplantation in a case of relapsed refractory central nervous system lymphoma]. 1293 63

Ganciclovir-resistant cytomegalovirus (CMV) infection is an emerging problem in transplant recipients. Foscarnet resistance and cidofovir resistance have also been described, but no previous reports have suggested treatment regimens for patients with CMV refractory to all three of these drugs. Leflunomide, an immunosuppressive drug used in rheumatoid arthritis and in rejection in solid-organ transplantation, has been reported to have novel anti-CMV activity. However, its clinical utility in CMV treatment has not been described previously. We report an allogeneic bone marrow transplant recipient who developed CMV infection refractory to sequential therapy with ganciclovir, foscarnet, and cidofovir. The patient was ultimately treated with a combination of leflunomide and foscarnet. Both phenotypic and genotypic virologic analysis was performed on sequential CMV isolates. The patient's high CMV-DNA viral load became undetectable on leflunomide and foscarnet, but the patient, who had severe graft-versus-host disease (GVHD) of the liver, expired with progressive liver failure and other complications. We concluded that leflunomide is a new immunosuppressive agent with anti-CMV activity, which may be useful in the treatment of multiresistant CMV. However, the toxicity profile of leflunomide in patients with underlying GVHD remains to be defined.
 ...
PMID:Use of leflunomide in an allogeneic bone marrow transplant recipient with refractory cytomegalovirus infection. 1548 72

The hematopoietic stem cell transplantation (HSCT) setting is a rapidly evolving field, and procedures with a high degree of complexity are now entering into the clinic. The risk of developing opportunistic viral infections increases with the level of human leukocyte antigen disparity between the donor and the recipient of allogeneic HSCT and is enhanced by graft manipulations such as T-cell depletion or immune suppression required to control graft versus host disease (GVHD) or rejection. Among the opportunistic viral infections potentially hampering the outcome of HSCT, human cytomegalovirus (HCMV) infection plays a major role. In the early 1980s, before the introduction of effective antiviral treatment, HCMV disease accounted for the high mortality in recipients of allogeneic HSCT. In more recent years, the availability of HCMV-specific antiviral agents (ganciclovir, GCV, foscarnet, PFA and cidofovir, CDV) led to a dramatic decrease in HCMV-related morbidity and mortality. However, HCMV infection still remains a major concern in the HSCT setting. Historically, treatment of HCMV infection in HSCT recipients (HSCTR) evolved from treatment of overt HCMV disease to universal prophylaxis or pre-emptive treatment of active infection, in parallel with the improvement of techniques for diagnosing and monitoring HCMV infection in transplant recipients.
 ...
PMID:Human cytomegalovirus load measurement and its applications for pre-emptive therapy in patients undergoing hematopoietic stem cell transplantation. 1838 49