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 studied occurrence, risk factors and outcome of patients with transplant-associated microangiopathy (TAM) after allogeneic stem cell transplantation (HSCT). A total of 221 consecutive patients were transplanted between 1995 and 2002. TAM is defined as evidence of hemolysis and schistocytes in the first 100 days. Outcomes analyzed included TAM and overall survival. Of 221 patients, 68 had TAM. The cumulative incidence was 31 (25-38)% at 100 days. Patients with TAM had higher LDH, higher bilirubin, higher creatinine and more often neurologic symptoms. TAM was not associated with stem cell source, cyclosporine levels and was not more frequent in recent years. In multivariate analysis, risk factors for TAM included donor type, age, gender, ABO-incompatibility and acute graft-versus-host disease (aGvHD). In patients with TAM, 1-year survival was lower than in patients without TAM (27 +/- 18% for TAM with high schistocyte counts; 53 +/- 15% for TAM with low schistocyte counts; vs 78 +/- 7% in patients without TAM; P<0.0001). TAM was independently associated with mortality adjusting for donor type, age and aGvHD occurrence and severity. TAM is frequent after HSCT and is associated with mortality even after adjustment for aGvHD grade. Risk factors of TAM are similar to aGvHD. TAM may represent endothelial damage driven by donor-host interactions.
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PMID:Transplant-associated microangiopathy (TAM) in recipients of allogeneic hematopoietic stem cell transplants. 1618 83

We describe two patients with acute myeloid leukemia successfully treated with anti-CD20 antibody for pure red cell aplasia (PRCA) following ABO-mismatched allogeneic hematopoietic stem cell transplantation (HSCT). PRCA following HSCT is associated with major ABO incompatibility between donor and recipient and is due to an inhibition of donor erythroid precursors by residual host isoagglutinins. The first patient developed PRCA resistant to several treatment options including donor-derived leukocyte infusions (DLI), high-dose erythropoietin (EPO), and rapid tapering of cyclosporin A (CsA). This patient also received anti-viral therapy as CMV and parvovirus B19 infections were regarded as additional causes of PRCA. Due to a loss of donor chimerism, he underwent second HSCT, but PRCA still persisted. He showed no evidence of graft-versus-host disease (GVHD). Finally he was administered anti-CD20 antibody (rituximab) at a dose of 150/m2 and PRCA resolved in a short period of time. The case was complicated by life-threatening pulmonary aspergillosis with septic shock, successfully treated with anti-fungal therapy. The second case concerns a patient, who revealed PRCA after major ABO-incompatible HSCT from his brother. Considering our experience with the previously described patient, he proceeded to rituximab at a dose of 150/m2 as first line treatment. We observed rapid recovery from PRCA without any side effects. We conclude that rituximab seems to be a promising therapeutic option in patients with PRCA after ABO-mismatched HSCT, in whom conventional treatment fails.
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PMID:Successful treatment of pure red cell aplasia with repeated, low doses of rituximab in two patients after ABO-incompatible allogeneic haematopoietic stem cell transplantation for acute myeloid leukaemia. 1626 24

Although related bone marrow transplantation (BMT) is effective for thalassemia, less than 30% of patients have sibling donors. Here, we report unrelated BMT in nine thalassemic children using a high-resolution HLA typing technique to identify donors. HLA mismatches between donors and recipients were 0, 1 and 2 in 2, 5 and 2 cases, respectively. The results showed that white blood cells, platelets and hemoglobin all returned to normal at various time points, and blood transfusion was eliminated from 13 to 62 days after transplantation. Full engraftment was achieved in eight patients while ABO blood types were replaced with that of donors in five of the six ABO mismatched recipients. Acute skin GVHD was found in seven patients and acute liver GVHD in one. One patient with acute intestinal GVHD eventually developed chronic GVHD. One patient died of pulmonary hemorrhage in spite of having a fully functional graft. We conclude that this is the first successful application of unrelated BMT for thalassemia major in Chinese people and that the results will certainly expand donor resources and greatly enhance the survival and quality of life of thalassemic patients.
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PMID:Unrelated donor bone marrow transplantation for beta-thalassemia major: an experience from China. 1627 16

Reports have shown a worse outcome for donor-recipient pairs mismatched for ABO blood groups in bone marrow transplantation (BMT). These studies, however, included small and heterogeneous study populations, and not all considered bidirectional ABO incompatibility separately. Because the issue remains controversial, we analyzed the effect of ABO mismatch on the overall survival, transplant-related mortality, and occurrence of acute and chronic graft-versus-host disease (GVHD) in a large homogenous group of patients undergoing allogeneic BMT. A total of 3103 patients with early-stage leukemia who underwent transplantation between 1990 and 1998 with bone marrow from an HLA-identical sibling and who were reported to the Center for International Blood and Marrow Transplant Research were studied. The median follow-up was 54 months. A total of 2108 (67.9%) donor-recipient pairs were ABO identical, 451 (14.5%) had a minor mismatch, 430 (13.9%) had a major mismatch, and 114 (3.7%) had a bidirectional ABO mismatch. The groups did not differ significantly in patient or donor characteristics except for more female-to-male sex mismatch in the bidirectional ABO mismatch group (P = .017). In multivariate models of overall survival, transplant-related mortality, and grade II to IV acute GVHD, there were no significant differences among the 4 groups. Bidirectional ABO mismatch was associated with a significantly higher risk of grade III or IV acute GVHD (hazard ratio, 1.869; 95% confidence interval, 1.192-2.93; P = .006). Patients with major ABO mismatch received red blood cell transfusions (P = .001) for a longer timer after transplantation and had a slightly slower neutrophil recovery (P < .001). There was no evidence of a substantial effect of ABO blood group incompatibility on the outcome of conventional BMT among patients with leukemia.
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PMID:ABO blood group barrier in allogeneic bone marrow transplantation revisited. 1633 23

Several recently published studies have suggested that patients who undergo ABO mismatched hematopoietic stem cell transplantation may be at increased risk for relapse, graft-versus-host disease, transplant-related mortality, and/or all-cause mortality. To investigate this issue further, we analyzed potential associations between the donor-recipient ABO mismatch pattern and the above outcome measures among 240 consecutive patients who underwent allogeneic hematopoietic stem cell transplantation at our institution. Our analyses uncovered no significant associations between donor-recipient ABO mismatch pattern and overall survival, event-free survival, transplant-related mortality, incidence of acute graft-versus-host disease (GVHD), or incidence of chronic GVHD. Our data do not support recent assertions that donor-recipient ABO mismatching is a major risk factor for patients undergoing allogeneic transplant, nor do they support recent assertions that ABO matching should be an important consideration in selecting allogeneic hematopoietic stem cell donors.
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PMID:Lack of effect of donor-recipient ABO mismatching on outcome following allogeneic hematopoietic stem cell transplantation. 1696 67

Late loss of kidney allograft, caused by immunological and non-immunological factors, remains a major problem in the field of transplantation. The aim of this study was to analyze the risk factors affecting long-term kidney graft survival more than 15 years. In a retro-spective analysis, clinical and laboratory variables and outcome of 330 patients who received a kidney transplant from living or cadaveric ABO-compatible donors at the Charles Nicolle Hospital, Tunis between 1986 and 2005 were recorded. A total of 58 patients who had follow-up data longer than 15 years constituted the subjects of this study. Patients were classified into two groups: Group I (Gp I), those who had kidney graft survival more than 15 years and Group II (Gp II), those who had kidney graft survival less than 15 years. There were 27 patients in Gp I (46.5%) and 31 in Gp II (53.5%). Graft loss in Gp II patients occurred in the first year in 15.1%, at three years in 35.5 %, at five years in 71 % and at 10 years in 83.9 %. The cause of graft loss was chronic graft dysfunction in 24 cases (77.4%), recurrence of the original kidney disease in three and graft versus host disease, urinary fistula, vascular rejection and graft rupture in one case each. There was no statistically significant difference between recipient and donor age or sex, duration on dialysis, number of acute rejections and infections between the two groups. Eleven of 27 patients (40.7 %) in Gp I and eight of 31 patients (25.8 %) in Gp II received total mismatched kidneys while the others received kidneys with varying degrees of match. The HLA DR2 matching was higher in Gp I (44.4 %) than in Gp II (29 %), whereas DR3 matching was higher in Gp II (45.2 %) in comparison with Gp I (11.1 %). Cross-match was negative in all our patients. Thirteen patients (48.1%) in Gp I and 17 (54.8 %) in Gp II.had a history of having episode(s) of acute rejection The number of acute rejection episodes did not contribute significantly to long-term graft survival in our series. Delayed graft function significantly lowered long-term graft survival; it was seen in seven cases in Gp I (25.9 %) versus 23 cases in Gp II (74.2 %) (X2=13.46). In our study, the long-term graft survival was similar to what is reported from developed countries. The main risk factors were HLA DR matching and delayed graft function.
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PMID:Immunological factors and renal allograft survival for more than fifteen years: a single center study from Tunisia. 1729 43

ABO incompatibility is not a barrier for allogeneic hematopoietic stem cell transplantation but is associated with specific complications. Major ABO incompatibility is associated with delayed erythroid engraftment, increased transfusion requirement and cases of pure red cell aplasia. Minor ABO incompatibility may be responsible for acute haemolytic reactions in the first months following transplantation. The widely used non myeloablative conditioning regimens might modify the management of ABO incompatibility. They could favour pure red cell aplasia development in the setting of major ABO mismatch since they are associated with a prolonged persistence of host anti-donor isohemagglutinins after allogeneic hematopoietic stem cell transplantation. In the setting of minor ABO incompatibility, the use of peripheral blood stem cells and the nature of graft-versus-host disease prophylaxis regimen may have an impact on the incidence of haemolytic reactions. In that review, the clinical and therapeutic aspects of ABO incompatibility are studied, especially regarding the impact of the conditioning regimen intensity.
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PMID:[ABO incompatibility and non myeloablative allogeneic stem cell transplantation]. 1746 38

Two hundred twenty-four patients with leukemia transplanted with an unrelated donor between 1991 and 2003 at the Karolinska University Hospital were analyzed according to association between graft failure and ABO, RhD, MNSs, and Kidd blood group antigen compatibility. Median age was 29 years (range: 0-55). Conditioning consisted of total-body irradiation or busulfan-based myeloablative conditioning. A bone marrow graft was given to 152 patients, and 72 patients received peripheral blood stem cells. Most patients received graft-versus-host disease prophylaxis with cyclosporine and MTX. Graft failure (GF) was seen in 6 (2.7%) patients. In the multivariate analysis major ABO mismatch (odds ratio [OR] 14.9, 95% confidence interval [CI] 2.01-110, P = .008) and HLA-allele mismatch (6.42, 1.19-34.8, P = .03) was significantly associated to GF. In patients with and without major ABO mismatch the incidence of GF was 7.5% and 0.6% (P = .02), respectively. Using an ABO major mismatched graft increases the risk for GF after unrelated donor hematopoietic stem cell transplantation.
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PMID:Major ABO blood group mismatch increases the risk for graft failure after unrelated donor hematopoietic stem cell transplantation. 1753 77

Transplant-associated microangiopathy (TAM) is a severe complication following allogeneic hematopoietic stem cell transplantation (HSCT) even after reduced-intensity conditioning (RIC). Data on 112 patients following RIC were analyzed with respect to TAM according to the ASBMT and risk factors, response to well-defined therapy and outcome were determined. TAM occurred in 11 of 112 patients. Univariate analysis determined acute graft-versus-host disease and ABO-incompatibility as risk factors for TAM. Treatment consisted of withdrawal of calcineurin inhibitors and plasma exchange (PE). Response to PE was 64%. PE seems to be an effective therapeutic option that should be assessed in larger patient cohorts.
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PMID:ABO-incompatible allogeneic hematopoietic stem cell transplantation following reduced-intensity conditioning: close association with transplant-associated microangiopathy. 1756 87

Allogeneic hematopoietic stem cell transplantation (HSCT) is an established curative therapy for a variety of hematologic malignancies. Genotypically HLA-identical sibling donors (ISDs)--who are available for about 30% of white patients are still considered as the best donors for HSCT. HLA-DPB1 is characterized by a high polymorphism, weak linkage disequilibrium with HLA-DR and -DQ loci, and its role as a transplantation antigen is controversial. We investigated the impact of HLA-DPB1 mismatch in HLA-identical sibling donor transplantation on a Graft-versus-host disease (GVHD). We Typed HLA-DPB1 by Innolipa in 33 patient-donor pairs with different hematologic diseases. Four (12.2 %) pairs with HLA-DPB1 mismatched were identified without identity. The incidence of grades II-IV aGVHD was higher in the HLA-DPB1 mismatched group (p=0.014, OR=26). Univariate analysis of risk factor for aGVHD II-IV showed that HLA-DPB1 is the only significant association (p=0.014), while non significant association was found between the age and sex of the patient, age of the donor, disease of the patient, and ABO compatibility, and positive CMV serology in patients and donors. It is concluded that HLA-DPB1 can mediate alloreactive responses and that HLA-DPB1 mismatch increases the risk of aGVHD in sibling donor stem cell transplantation.
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PMID:HLA-DPB1 mismatch and acute graft-versus host disease in HLA-identical sibling donors. 1797 7


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