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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bone marrow transplantation is emerging as a viable therapeutic approach to a number of diseases that are usually or uniformly fatal. We review here recent experiences in bone marrow transplantation in man at UCLA and in various other institutions throughout the world. We examine marrow transplantation in immunodeficiency diseases, acute leukemia, and aplastic anemia and consider the problems of infection in the transplant recipients. The applications of tissue typing to marrow transplantation and immunologic manipulations, which may influence engraftment and graft-versus-host disease, are also reported.
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PMID:Bone marrow transplantation in man. 0 Sep 37

Bone marrow transplantation is an experimental approach to the treatment of patients with acute leukemia, aplastic anemia, and other neoplastic and genetic diseases. To date, long-term disease-free survival has been achieved in a small proportion of carefully selected patients with resistant acute leukemia. While results are not optimal, they are acceptable in late stage patients where there are no effective alterates. Major problems in marrow transplantation for leukemia include tumor resistance and a spectrum of immunologic complications including GVHD, immunodeficiency, and interstitial pneumonitis. Potential approaches to these problems have been suggested. Progress in any one area would have a substantial impact on improving survival and extending the applicability of marrow transplantation to patients at an earlier stage of their disease.
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PMID:Bone marrow transplantation in acute leukemia: current status and future directions. 4 7

Ionizing radiation used for diagnosis or therapy has been associated with an increased incidence of malignancies of blood-forming organs. The increased incidence of hematopoietic malignancies following exposure to ionizing radiation obtained in the course of occupation, diagnosis and therapy of disease, or as a weapon of war is documented. The natural occurrence and the induced progression to acute leukemia of polycythemia rubra vera, Hodgkin's disease, multiple myeloma, Di Guglielmo's disease, and reticuloendothelial malignancies are discussed. The status of transplantation and immunodeficiency states and their relationship to acute leukemia is reviewed. Finally, drugs, toxins, and the use of cytotoxic radiomimetic agents for nonmalignant purposes are shown to lead to the development of acute leukemia. Background information relevant to the proper use of future diagnostic and therapeutic modalities is provided.
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PMID:Malignancies in blood-forming organs following diagnostic and therapeutic procedures: a review. 106 32

Remission rate of leukemia has been improved by development of recent antileukemic chemotherapy. But opportunistic infection in secondary immunodeficiency has increased. Especially pulmonary mycoses often occurs and its prognosis is poor. But if patient with leukemia complicates pulmonary mycoses, it should be cured as soon as possible and antileukemic chemotherapy should be continued. We successfully performed surgical treatment for 2 pulmonary aspergillosis, which were complicated in stage of remission induction of acute leukemia.
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PMID:[Two resected cases of pulmonary aspergilloma in acute leukemia]. 237 11

Human immunodeficiency virus (HIV-1) can be transmitted by blood transfusions. A recent report focused on the relativey high risk of HIV-1 infection in American patients treated for leukemia and multiply transfused as a consequence of therapy. We therefore conducted a retrospective study on the presence of HIV-1 antibodies among 91 acute leukemia patients diagnosed between 1978 and 1985, before the onset of routine tests for HIV-1 contamination of blood products. The transfusion requirement (platelet units, red blood cell concentrates) involved almost 7,000 donors. We did not find any case of seropositivity in patients transfused with units from the donor pool. The only case of HIV-1 seropositivity was due to a bone marrow transplant donor, retrospectively found to be HIV-1 seropositive. These results differ from the American data previously cited. This is probably due both to differences in diffusion of the HIV-1 infection in the two countries and to differences in the selection of the two donor populations. We conclude that the risk of contracting HIV-1 infections before 1985 through multiple transfusions from registered donors in our Italian area was very low, if not absent, not only for leukemia patients but reasonably for other categories of heavily transfused groups.
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PMID:Human immunodeficiency virus testing in acute leukemia patients transfused between 1978 and 1985: a retrospective study on 91 cases. 250 11

The human immunodeficiency virus (HIV) is transmitted by sexual contact and by blood products. Patients with acute leukemia are extensively transfused as part of their supportive care. We conducted a retrospective study of the incidence of HIV antibody positivity in patients treated for acute leukemia at The Mount Sinai Medical Center between 1970 and 1986. Serum samples from 106 patients were studied, including 71 (67%) with at least one posttransfusion specimen. Six were found to have HIV antibodies. All positive specimens occurred in patients treated between 1980 and April 1985, when mandatory HIV testing of blood donors began. Twelve percent of the 51 patients studied from this time period underwent seroconversion documented by the presence of HIV-negative specimens prior to transfusion. These results show that these extensively transfused patients were at significant risk for HIV infection during the time period 1980 to April 1985.
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PMID:Human immunodeficiency virus infection in transfused patients with acute leukemia. 274 72

To determine the prevalence of cardiac abnormalities in patients with human immunodeficiency virus (HIV) infection, two-dimensional Doppler echocardiography was performed on 70 consecutive patients with HIV infection, including 51 with acquired immunodeficiency syndrome (AIDS), 13 with AIDS-related complex and 6 with asymptomatic HIV infection. Of the 70 patients, 36% were hospitalized and 64% were ambulatory at the time of evaluation. The average age was 37 years; 93% were homosexual men. Echocardiographic findings included dilated cardiomyopathy in eight patients (11%), pericardial effusions in seven patients (10%) (one with impending tamponade), pleural effusion in four patients (6%) and mediastinal mass in one patient (1%). Among the 25 hospitalized patients, echocardiographic abnormalities were noted in 16 (64%), whereas among the 45 ambulatory patients, the only abnormality noted was mitral valve prolapse in 3 patients (7%) (p less than 0.0001). Dilated cardiomyopathy was the only echocardiographic lesion more common in the 25 hospitalized patients than in 20 hospitalized control patients with acute leukemia. Symptoms of congestive heart failure responded to conventional therapy. Cardiac lesions were associated with active Pneumocystis carinii pneumonia and low T helper lymphocyte counts. Dilated cardiomyopathy of unknown origin may be more common than was previously recognized in hospitalized, acutely ill patients with AIDS, but is uncommon in ambulatory patients with HIV infection. Echocardiography should be considered in the evaluation of dyspnea in hospitalized patients with HIV infection, especially those with dyspnea that is out of proportion to the degree of pulmonary disease.
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PMID:Cardiac manifestations of human immunodeficiency virus infection: a two-dimensional echocardiographic study. 292 51

Although the etiology of acute leukemia is largely unknown, some facets of the puzzle are becoming clarified. Recognition of important patterns in age-specific mortality rates has suggested that events early in life, perhaps even prenatally, may have an influence on developing leukemia in childhood. The racial differences evident in mortality, incidence, and immunologic subtype of ALL suggest either differences in exposures to certain "factors" or differences in responses to those "factors" by white children. Hereditary factors appear to play a role. Familial and hereditary conditions exist that have high incidences of acute leukemia. Chromosomal anomalies are common in these conditions. Viral infections may play a role by contributing to alteration in genetic material through incorporation of the viral genome. How that virus is dealt with after primary infection seems important. The presence of immunodeficiency may allow wider dissemination or enhanced replication of such viruses, thereby increasing the likelihood of cellular transformation to an abnormal cell. Proliferation of that malignant cell to a clone may depend on other cofactors. Perhaps prolonged exposure to substances like benzene or alkylating agents may enhance these interactions between virus and genetic material. Does this change DNA repair mechanisms? Are viral infections handled differently? Is viral genomic information more easily integrated into host cells? Ionizing radiation has multiple effects. Alteration in genetic material occurs both at the molecular and chromosomal levels. DNA may be altered, lost, or added in the cell's attempt to recover from the injury. These changes may lead to altered susceptibility to other environmental agents, and host response may be altered. The past 40 years have seen dramatic progress in the treatment of ALL. We have just begun to unravel the complex interactions of genetic makeup, immune response, and the environment on the development of ALL. Whether factors can be identified that may allow prevention of acute leukemia remains to be seen.
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PMID:Epidemiology of acute lymphoblastic leukemia. 385 24

Two patients with acute leukemia were treated with chemoradiotherapy and allogeneic bone marrow transplantation. Despite the prophylactic use of methotrexate after grafting, both patients developed severe graft-versus-host disease that was refractory to treatment with methylprednisolone. The graft-versus-host disease was then treated with a monoclonal antibody, 64.1, that reacts with a p19 antigen on human T cells. The disease responded dramatically to this treatment, but both patients subsequently developed a fatal polyclonal lymphoproliferative disorder arising in donor-derived B cells. Hybridization studies showed Epstein-Barr virus in both tumors. The combined effect of severe end-stage graft-versus-host disease and potent immunosuppressive therapy probably resulted in a progressive immunodeficiency syndrome that abrogated the T-cell-mediated surveillance mechanism that normally modulates the proliferation of Epstein-Barr-virus-infected B lymphocytes.
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PMID:Fatal Epstein-Barr-virus-associated proliferation of donor B cells after treatment of acute graft-versus-host disease with a murine anti-T-cell antibody. 608 3

Cell surface marker analyses conducted on human peripheral blood lymphoid cells have proven extremely useful in the diagnosis of immunodeficiency and the diagnosis and staging of malignancies. In this paper we have focused on the ratio of helper to suppressor cells in patients with the acquired immune deficiency syndrome and in patients with malignancy. In thirty-three patients with the acquired immune deficiency syndrome, the majority showed an inverted helper:suppressor ratio, elevated serum thymosin alpha 1, and elevated serum lysozyme levels. The inverted ratio was due to a deficiency in T-helper cells. The inverted helper:suppressor ratio was associated with functional suppressor cell activity that was seen in 12 out of 21 patients examined. Patients' lymphocytes were found to suppress the PHA, pokeweed mitogen, and concanavalin-A responses of normal subjects' lymphocytes. The suppression also correlated with impaired lymphocyte proliferative responses among the patients' cells themselves. Because of these findings, the helper:suppressor ratio was studied in patients with solid tumors, lymphoma, acute leukemia, chronic lymphocytic leukemia, and hairy cell leukemia. Approximately 30% of these patients have an inverted helper:suppressor ratio. However, in ten out of 30 patients with chronic lymphocytic leukemia and in three out of 45 patients with lymphoma, the helper:suppressor ratio was elevated, being greater than 3.0. The significance of these findings is as yet to be explored, but it is suggested that an inverted helper:suppressor ratio in patients with malignancy may relate to an advanced stage of disease or a poor prognosis. Documentation of this point will require further study.
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PMID:Leukocyte subset analysis and related immunological findings in acquired immunodeficiency disease syndrome (AIDS) and malignancies. 623 50


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