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 have studied long-term engraftment in 24 multiply transfused patients transplanted for severe aplastic anaemia (SAA) 2-7 years previously from HLA identical sibling donors. All 24 patients had engrafted initially; nine (38%) developed grade II-IV a-GVHD, but only 5 (21%) developed chronic GVHD, which was mild, localized and transient. In 22 cases DNA 'fingerprint' analysis using a hypervariable minisatellite DNA probe (33.15) confirmed the donor/recipient origin of patient peripheral blood (PB) nucleated cells. Red cell antigens and PB lymphocyte chromosomes were also analysed in informative cases. In 19 patients (79%) PB cells were of donor origin confirming sustained engraftment, whereas five (21%) had PB cells of recipient origin. In four of these five cases complete autologous reconstitution was demonstrated. In one case DNA fingerprinting revealed mixed haemopoietic chimaerism. In three of the four cases of autologous reconstitution there had been a previous episode of late graft failure. The low incidence of chronic GVHD in the study group was not explained by autologous reconstitution or mixed chimaerism. We conclude that the hypervariable minisatellite probes are valuable in the study of engraftment after BMT, especially when patient and donor are HLA identical, of the same sex, and have the same ABO-Rh blood type. Pre-transplant specimens from the patient are not necessary for interpretation of the results provided that DNA from the donor is available.
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PMID:Use of a hypervariable minisatellite DNA probe (33.15) for evaluating engraftment two or more years after bone marrow transplantation for aplastic anaemia. 284 32

We have tested 10 bone marrow transplant donors and recipients for ABH and Lewis antigens and ABH antibodies. Two group A2 recipients stably engrafted with group O marrow produced anti-A1. Small quantities of recipient-type ABH substance were found on the posttransplant erythrocytes in cases where the recipient was a secretor but not in a single nonsecretor recipient. Lewis antigens were always of recipient type. The incidence of graft-versus-host disease and graft rejection were similar in 41 patients who received ABO-mismatched and 61 patients who received ABO-matched grafts.
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PMID:ABH and Lewis antigen and antibody expression after bone marrow transplantation. 311 2

Twelve of 58 (21%) evaluable patients of blood group 0 who received a bone marrow transplant (BMT) from an HLA-matched sibling of a donor of group A or B developed significant immunohematologic problems in the posttransplant period. Anti-A or anti-B isohemagglutinins persisted for longer than 120 days post-BMT in nine patients and are still present in three patients at days +162 to +605. Red cell production as indicated by a reticulocyte count of greater than 0.5% was delayed to 40 days or more in nine patients, and in five of these was markedly delayed to 170 days or longer. One patient does not as yet have red cell production on day +605 in spite of having had 13 plasma exchanges performed to reduce the anti-B titer. Five patients experienced overt hemolysis, manifested by a sudden drop in hemoglobin of 1.5 to 4 gm/dl (median = 2.5 mg/dl), starting on day +37 to +105 (median = +65), persisting for 10 to 94 days (median = 36 days). Hemolysis and a delay in the onset of erythropoiesis beyond 170 days were more frequent in 30 patients treated with cyclosporine/prednisone than in 28 patients treated with methotrexate/prednisone for graft-versus-host disease prophylaxis. Our data indicate that ABO major mismatched BMT can be associated with significant immunohematologic consequences, some of which occur more frequently in association with cyclosporine administration.
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PMID:Immunohematologic consequences of major ABO-mismatched bone marrow transplantation. 327 75

If ABO antigens/antibodies play any role in the pathogenesis of acute graft-versus-host disease (GVHD), one would expect the highest incidence of GVHD in recipients of minor ABO-mismatched grafts, followed by ABO-matched grafts, and the lowest incidence in major ABO-mismatched transplants. To test this hypothesis 174 patients receiving an HLA-identical allogeneic bone marrow transplant (BMT) for aplastic anemia (n = 32) or leukemia (n = 142) were analyzed for factors associated with acute GVHD. Variables analyzed included diagnosis, sex, age, blood group of donor and recipient, ABO compatibility, Rhesus compatibility, sex compatibility, number of bone marrow cells given at BMT, year of transplant, day of engraftment, and GVHD prophylaxis. We first carried out an exploratory contingency table analysis: minor ABO incompatibility was associated with a significantly higher risk of severe acute GVHD when compared with ABO-matched and major-ABO mismatched pairs (P = 0.003): 14/9, 57/67, and 5/22 patients developed, respectively, 0-I/II-IV acute GVHD in ABO major-mismatched, matched, and minor-mismatched pairs. Donors of group 0, (P = 0.06), older recipient's age (P = 0.08), fast engraftment (P = 0.03), and older donor's age (0.08) were also associated with a higher risk of GVHD. Recipient's ABO group, diagnosis, year of transplant, Rhesus group of donor or recipient, Rhesus compatibility, sex of donor or recipient, sex compatibility, and type of GVHD prophylaxis were not predictive of GVHD. A Cox multifactorial proportional hazards analysis confirmed that ABO matching was the single most significant factor associated with GVHD (P = 0.006). The cumulative incidence of GVHD grade II+ was 39%, 54%, and 82% for ABO major-mismatched, matched, and minor-mismatched pairs (P = 0.01). This study suggests that ABO antigens may play a role in the development of acute GVHD.
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PMID:ABO compatibility and acute graft-versus-host disease following allogeneic bone marrow transplantation. 328 50

Allogenic bone marrow transplantation was performed in a patient with chronic myelocytic leukemia (Ph+) in a stable phase. A 1,5-year recurrence-free period since the time of transplantation was observed. Transplantation features were as follows: incompatibility of the recipient and donor by ABO-antigens, the development of acute graft versus host disease and transient Ph-positivity.
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PMID:[A case of successful transplantation of allogeneic bone marrow in a patient with myelocytic leukemia]. 330 11

Bone marrow transplantation results in the infusion of 150 to 360 ml of erythrocytes. While this poses no problem to a recipient of marrow from an ABO-compatible donor, it clearly represents a serious risk of intravascular hemolysis for the recipient of an ABO-incompatible marrow. Thus, there is a need for removing incompatible erythrocytes from the marrow preparation. We removed erythrocytes from the marrow preparations by automated centrifugation. The erythrocyte-depleted marrow (EDM) contained a mean of 5 ml erythrocytes, representing an average reduction of 98%. The mean mononuclear cell recovery was 88%, resulting in a mean infusion of 0.6 X 10(8) cells/Kg of recipient's body weight in a final average volume of 155 ml. EDM was infused into 22 ABO-incompatible marrow recipients (21 patients with hematologic malignancies and one patient with aplastic anemia) without clinical evidence of hemolysis. The isohemagglutinin titers of recipients ranged from 4 to 4096 and were not lowered prior to infusion. Engraftment (i.e., recovery of peripheral leukocyte and platelet counts) and incidence of graft versus host disease were similar to those observed in recipients of ABO-compatible marrow transplantation. Erythrocyte engraftment was significantly delayed in only one patient who had a high isohemagglutinin titer. The post-transplantation red cell requirement was increased in EDM recipients: 9 units compared to 6 units in ABO-compatible bone marrow transplanted patients with neither hemolysis nor interference with successful engraftment.
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PMID:Erythrocyte depletion of ABO-incompatible bone marrow. 389 6

The management of hemotherapy in 31 cases of ABO- or Rh-incompatible bone marrow transplantation is described. Our experience confirms that ABO or Rh incompatibility does not adversely affect engraftment, patient survival, or incidence of graft-versus-host disease. Eighteen recipients with ABO antibodies against the donors' red cells (major incompatibility) were managed by different combinations of plasma exchange, transfusion of incompatible donor type red cells, and removal of donor-type red cells from the bone marrow before transplant. The only serious complication was delayed hemolysis in seven of nine patients who received incompatible red cell transfusions before transplant. Thirteen patients received bone marrow containing ABO antibodies against their red cells (minor incompatibility). Five were managed by centrifuging the bone marrow to remove plasma and reduce the amount of antibody. This did not cause substantial loss of stem cell activity (60-100% of original marrow), and no patients had complications related to the marrow transfusion. In contrast, two of seven patients who received uncentrifuged bone experienced hemolysis. Two of four Rh positive recipients who received marrow from an Rh negative donor developed anti-D, possibly due to Rh positive blood components transfused after transplantation. None of eight Rh negative patients who received an Rh positive transplant has developed anti-D. Blood components should be selected to avoid transfusion of incompatible red cells and to avoid transfusion of a large amount of incompatible plasma. This may necessitate use of plasma components of a different ABO type than the red cell components.
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PMID:Hemotherapy in patients undergoing blood group incompatible bone marrow transplantation. 641 May 49

A caucasian female infant with acute lymphoblastic leukaemia in second remission received a bone marrow transplantation. Engraftment was confirmed at 14 days following infusion of bone marrow from a sex-matched, ABO and HLA compatible sibling. 171 days posttransplantation the patient is clinically well and in haematological remission. A mild transient skin rash and hepatocellular disturbance, the only manifestations of graft versus host disease, responded successfully to high dose prednisone.
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PMID:Bone marrow transplantation in a child with acute lymphoblastic leukaemia. 699 92

ABO incompatible allogeneic bone marrow transplants can be performed successfully to treat patients with leukemia or aplastic anemia. These transplants carry no great risk of rejection or graft-versus-host disease, however, some method must be used to avoid acute hemolysis at the time of infusion of ABO incompatible marrow. We have used successfully large volume plasma exchange to remove anti-A or anti-B antibodies prior to marrow infusion. More recently we have used immunoadsorbent columns containing synthetic A or B antigen specifically to remove anti-A or anti-B antibodies in lieu of plasma exchange. These columns are better tolerated than plasma exchange where allergic reactions are common.
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PMID:Plasma exchange and immunoadsorption for removal of antibodies prior to ABO incompatible bone marrow transplant. 703 Feb 80

We analyzed data from 81 ABO-incompatible marrow transplants performed between 1972 and 1980. Patients with high anti-red blood cell antibody levels pretransplant had a significantly increased probability of antibody return post-transplant. This was true for IgG and for IgM as independent variables. However, the return of antibody post-transplant had no effect on engraftment, survival, or blood product requirements posttransplant. Patients who received ABO-incompatible marrow had a similar time to engraftment, survival, and incidence of rejection and graft-versus-host disease as patients receiving ABo-compatible transplants. Neither pretransplant treatment regimen nor the development of graft-versus-host disease had an effect on post-transplant antibody levels. ABO-incompatible marrow transplants can be performed with no greater morbidity or mortality than ABO-compatible grafts. The procedures for antibody removal may be useful in other organ transplant settings.
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PMID:ABO-incompatible marrow transplants. 704 68


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