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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)

Transfer of fetal red blood cells and platelets to the maternal circulation can stimulate an immune response with production of immunoglobulin that can cross the placenta. Similarly, passage of maternal stem cells to an immunologically incompetent fetus can theoretically produce graft-versus-host disease. disease. Maternal sensitization to red blood cell antigens such as D and Kell can result in anaemia, hydrops, and death in an incompatible fetus. Current assessment of these pregnancies involves serial analysis of amniotic fluid bilirubin concentration, with umbilical cord blood sampling reserved for special circumstances; neither ultrasound or Doppler blood flow analysis are accurate in the prediction of fetal haematocrit. Intravascular transfusion is the treatment of choice for hydropic fetuses. Perinatal survival in non-hydropic fetuses is similar with either intravascular or intraperitoneal transfusion, and the choice of procedures is individualized. Isoimmune fetal thrombocytopenia is usually the result of maternal sensitization to the PlA1 antigen. There is significant risk of intracranial haemorrhage, both antepartum and during labour and delivery. Umbilical cord blood sampling at term can determine fetal platelet count and the need for platelet transfusion, and can aid in deciding the appropriate route of delivery.
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PMID:Alloimmune conditions and pregnancy. 144 20

Cytomegalovirus (CMV) is the most common cause of interstitial pneumonia following bone marrow transplantation. CMV pneumonia (CMV Pn) is particularly worrying after allografts since its incidence and severity are closely linked to graft-versus-host disease (GVHD). In similarly conditioned patients, the risk of CMV Pn is the same after autografts and allografts without GVHD; it is inexistant in bone marrow transplantations between twins. These findings, together with numerous experimental data, make CMV Pn a model of viral pneumonia in which the severity of the pneumonia seems to correlate mainly with an immunological reaction that is toxic for pulmonary cells, and CMV acts as a triggering agent rather than as a direct pathogen. As regards treatment, the ganciclovir-immunoglobulins combination has been very encouraging in the first patients treated, but as its mode of action is uncertain our enthusiasm must be tempered, especially since the results recently obtained in a greater number of patients seems to be less favourable than the initial results. The effectiveness of this costly drug combination, which in practice should be reserved for patients who received allografts or autografts plus pulmonary radiotherapy, deserves a more precise re-evaluation.
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PMID:[Clinical, diagnostic and physiopathological aspects of cytomegalovirus pneumonia after bone marrow transplantation]. 196 51

Depletion of T-cells in allogenic bone marrow transplants by means of immunological or immunophysical methods has proved highly successful in preventing acute and chronic graft-versus-host disease (GvH) (less than 10% GvH above grade II, as opposed to 41% in historical series). However, T-cell depletion has been found to induce resistance to engraftment in 10 to 20% of the cases, and it may increase the incidence of relapses. Secondary complications can be prevented either by using in vivo monoclonal antibodies specific to the radio-resistant cells of the host, or by reinforced conditioning with a dual purpose: eradication of the residual immunocompetent cells in the host, and greater activity against the imperceptible tumoral mass. If subjects at high risk of GvH could be detected by means of predictive tests currently under evaluation, T-cell depletion could be reserved to that category of patients.
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PMID:[Prevention of the graft-versus-host disease by T-cell depletion in allogenic bone marrow transplantation]. 296 75

A review of studies on the effect of different types of gastrointestinal decontamination and protective environment on infectious complications in granulocytopenic patients is given, and the effect of these measures on graft-versus-host disease after allogeneic bone marrow transplantation is discussed. It is concluded that complete gastrointestinal decontamination of patients nursed under conditions of strict reverse isolation will maximally prevent infections, graft-versus-host disease, and lung complications and therefore is the treatment to be preferred for patients undergoing bone marrow transplantation. Since selective decontamination is as effective in preventing bacterial and fungal infections as is complete decontamination, this treatment is to be preferred for other patients with a greatly reduced resistance to these infections. The reason is that, for this type of patient, selective decontamination can be performed without the use of strict isolation facilities and in this way is less laborious and less of a burden for the patient. Besides this, the number of patients that can be treated will not be limited by the number of available facilities for strict reverse isolation, which can be reserved for bone marrow transplant patients.
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PMID:Management of bacterial and fungal infections in bone marrow transplant recipients and other granulocytopenic patients. 305 42

The current use of allogeneic bone marrow transplantation in various hematologic diseases is reviewed. Bone marrow transplantation (BMT) involves infusion of bone marrow from a suitable donor into a properly conditioned recipient. Most BMT is allogeneic, in which the donor is genetically dissimilar but shares some common tissue antigens with the recipient. Almost all patients undergoing allogeneic BMT must be "prepared" with high-dose cyclophosphamide to prevent graft rejection. Most patients with hematologic malignancy also receive total body irradiation to eradicate malignant cells located in areas inaccessible to the systemic circulation. Bone marrow transplantation is the treatment of choice for severe aplastic anemia. In acute myelogenous leukemia, the best results are observed in young patients undergoing BMT in first remission. In acute lymphoblastic leukemia, BMT is usually reserved for patients in second or subsequent remission. Early results are promising in patients with chronic myelogenous leukemia who receive BMT before the accelerated phase or blast crisis of this disease. Allogeneic BMT offers an opportunity for cure in some patients with relapses of Hodgkin's disease or those with certain subtypes of non-Hodgkin's lymphoma. Other diseases for which BMT has been used include severe combined immune deficiency disease, Fanconi's anemia, and multiple myeloma. Complications of BMT include graft failure or rejection, acute and chronic graft-versus-host disease, and infectious complications; late complications, such as restrictive and obstructive pulmonary disease, cataracts, sterility, and secondary malignancies, may also occur. Bone marrow transplantation has become an important treatment for many hematologic diseases, but it will probably remain a treatment reserved for only a few highly specialized centers. If morbidity and mortality caused by transplant-related complications can be reduced, BMT may be offered to older patients and those without HLA-identical sibling donors.
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PMID:Allogeneic bone marrow transplantation in the treatment of hematologic diseases. 388 73

The use of the recombinant hematopoietic growth factors G-CSF and GM-CSF have shortened the period of neutropenia, or avoided this problem, in many cancer patients who have received cytotoxic therapy. Although these benefits have been particularly striking in the autologous bone marrow and/or autologous peripheral blood progenitor cell transplant setting, most data suggest that the use of G-CSF and GM-CSF only marginally enhance recovery of the neutrophil count when administered after allogeneic bone marrow infusion. Furthermore, in the allograft setting these expensive agents have not provided benefit in the form of enhanced platelet count recovery, lessening the incidence of graft-versus-host disease, or improvement in overall survival. These data do not justify routine widespread use of G-CSF and GM-CSF and suggest that these agents should be reserved for patients who experience delay in engraftment after allogeneic bone marrow infusion. Administration of erythropoietin, on the other hand, may reduce the need for homologous red blood cell transfusions, and may increase the safety margin for both the allogeneic bone marrow recipient and as well as the donor. Recombinant hematopoietic growth factors targetted specifically to enhance platelet recovery after transplantation (such as interleukin-3, interleukin-6, and interleukin-11) have shown promise after autotransplantation and after conventional dose chemotherapy, and likely will be evaluated in the allogeneic transplant patient.
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PMID:Clinical use of hematopoietic growth factors in allogeneic bone marrow transplantation. 752 6

Multivisceral transplantation, combined liver-intestine transplantation, and isolated small bowel transplantation are very similar procedures that were first developed in the 1950s. If the viscera can be conceptualized as a cluster of grapes hanging from its arterial stems, the three procedures are characterized by virtually identical vascular anastomoses, with exclusion or inclusion of as many viscera (grapes) as necessary; however, these procedures languished for nearly four decades because of the imperfect immunosuppressive regimens of the 1960s, 1970s, and 1980s. Finally, after the development of FK506, pediatric patients may undergo intestinal transplantation with the hope for long-term survival. These procedures are reserved for TPN-dependent children with permanent intestinal insufficiency. Candidacy for transplantation is also predicated on development of potentially fatal TPN complications such as cholestasis, recurrent sepsis, or thrombosis of access sites. Since 1990, 32 pediatric patients have undergone intestinal transplantation at the University of Pittsburgh, with an overall survival of 65%. Immunosuppression has been accomplished with a combination of corticosteroids, FK506, and prostaglandin E1. Although GVHD has not been a major problem, most patients have experienced rejection episodes requiring intensification of immunosuppression with a steroid bolus, a steroid recycle, an increase in FK506 dosage, or addition of OKT3. CMV has caused little morbidity, but EBV-related PTLD has affected 20% of all patients. It has not been possible to discontinue immunosuppression in the face of PTLD without engendering severe small intestinal rejection. Other problems have included recurrent sepsis, intestinal dysmotility, and persistent food avoidance. Future therapeutic trends are likely to include the performance of combined bone marrow-visceral transplant to induce a chimeric tolerogenic state and to lessen the need for long-term immunosuppression.
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PMID:Small bowel transplantation in infants and children. 769 29

Patients with multiple myeloma must be distinguished from those with monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Therapy should be reserved for patients with active or symptomatic multiple myeloma. The pertinent literature on the diagnosis of multiple myeloma, prognostic factors, chemotherapy, and allogeneic bone marrow transplantation, as well as autologous peripheral blood or bone marrow stem cells for rescue, was reviewed. The two most powerful prognostic factors for multiple myeloma are the bone marrow plasma cell labeling index and the beta 2-microglobulin level. Chemotherapy is the preferred initial treatment for overt, symptomatic multiple myeloma. Combinations of alkylating agents produce a higher response rate, but the survival is the same as treatment with melphalan and prednisone. The combination of alpha 2-interferon with multiple alkylating agents produces a good response. alpha 2-Interferon prolongs the duration of the plateau state after a response to chemotherapy, but it apparently does not prolong survival. Allogeneic bone marrow transplantation is possible for only 5-10% of patients with multiple myeloma. Its advantage is that the graft contains no tumor cells that can subsequently produce a relapse. However, there is a significant early mortality, the risk of graft versus host disease is troublesome, and relapse of multiple myeloma is common. Autologous bone marrow transplantation is applicable for more patients because the age limit is higher and a matched donor is unnecessary. However, two major problems exist: (1) eradication of multiple myeloma from the patient may not occur even with large doses of chemotherapy and irradiation, and (2) infused autologous bone marrow or peripheral blood stem cells contaminated by myeloma cells or their precursors may be responsible for relapse.
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PMID:Newer approaches to the management of multiple myeloma. 824 81

Allogeneic transplantation is the only form of therapy that enables physicians to cure patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) who do not respond to induction therapy. Thus, patients and family members should be human leukocyte antigen (HLA)-typed soon after the diagnosis to expedite transplantation should induction therapy fail. Transplantation is superior to chemotherapy in patients with AML in second remission. The role of transplantation in ALL other than induction failure is somewhat different in children than in adults. Transplantation appears to be the treatment of choice in children with ALL in second remission regardless of the characteristics of the disease. Adults who relapse off-therapy after prolonged remission should probably be reinduced, whereas those with short remissions probably should go directly to transplant. Transplants from family members incompatible for one antigen result in survival rates similar to those observed with HLA-identical sibling transplants, but transplants from family donors mismatched for two or three antigens have been associated with a substantial increase in graft-versus-host disease (GVHD) and other complications and such transplants should be reserved for patients with few other prospects for cure. Randomized trials are underway to compare peripheral blood stem cells mobilized with granulocyte colony stimulating factor to marrow for H LA-matched transplantation. Results with unrelated donor transplants have improved with time and are approaching those for matched sibling transplants. Early results suggest that umbilical cord blood transplants are feasible with more graft failure but less GVHD than with unmodified marrow.
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PMID:Allogeneic hematopoietic stem cell transplantation for acute leukemia. 904 97

Bone marrow transplantation is an effective therapy for aplastic anemia. Infusion of allogeneic hematopoietic stem cells after high-dose immune suppression restores normal hematopoiesis in most patients and long-term follow-up has confirmed the durability of donor hematopoiesis. However, success of this approach is limited by transplant-related complications, such as graft failure, graft-versus-host disease, and various organ toxicities. Long-term survival rates range from less than 40% to more than 90% in reported series. These rates have improved over the past 20 years due to significant reductions in graft-versus-host disease, interstitial pneumonitis, and early transplant-related mortality. Most long-term survivors have excellent performance status. Late effects such as cataracts, thyroid disorders, joint problems, and therapy-related cancers are observed, especially in patients who received radiation for pretransplant conditioning. Results are best in young patients transplanted with bone marrow from a human leukocyte antigen (HLA)-identical sibling; early transplantation is appropriate in this group. For older patients or those without an HLA-identical related donor, transplants are better reserved for those who fail to respond to immunosuppressive therapy.
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PMID:Current status of allogeneic bone marrow transplantation in acquired aplastic anemia. 1067 9


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