Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023473 (chronic myeloid leukemia)
 18,916 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is no general agreement about the effect of an enlarged spleen on the outcome after bone marrow transplantation (BMT) for chronic myeloid leukaemia (CML). In this retrospective analysis, we compared rate of engraftment, haematological recovery and survival in 42 CML BMT recipients, 19 with splenomegaly and 23 without. Other variables analysed included interval from diagnosis to BMT, disease status at BMT, conditioning regimen, additional splenic irradiation, marrow cell dose, donor recipient ABO match and graft-versus-host disease. In multivariate analysis, the only significant variable was the presence or absence of splenomegaly. Splenomegaly was significantly correlated with delayed engraftment and graft failure. Patients with delayed engraftment experienced higher mortality, largely due to sepsis. These results emphasize the adverse impact of splenomegaly upon BMT survival in CML, and suggest that splenic irradiation does not favourably affect the early outcome after BMT.
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PMID:Delayed engraftment associated with splenomegaly in patients undergoing bone marrow transplantation for chronic myeloid leukaemia. 233 36

We treated 17 patients with chronic myeloid leukemia (CML) by bone marrow transplantation using marrow from human leukocyte antigen (HLA)-matched unrelated donors. Patients were conditioned with a combination of in vivo monoclonal antibodies, chemotherapy with daunorubicin (n = 7) or busulfan (n = 10) and cyclophosphamide, and both total body and total lymphoid irradiation. Donor marrow was depleted of T cells by incubation with monoclonal antibodies of the Campath series. Fourteen (88%) of 16 evaluable patients had sustained engraftment. Four (27%) of the 15 evaluable patients developed acute graft-versus-host disease (GVHD) of grade II or greater, and 4 of 12 evaluable patients developed chronic GVHD. Three patients developed hematological and two developed cytogenetic evidence of relapse. Eight patients (47%) survive at a median follow-up of 32 months (range 10-51 months), giving an actuarial survival of 44%. Five patients remain alive without evidence of hematological or cytogenetic relapse, giving an actuarial disease-free survival of 27%. Pneumonitis caused or contributed to death in six of the nine patients who died. We conclude that T-cell depletion can prevent the severest forms of GVHD but also increases the risk of relapse after transplant with unrelated donors, as it does with HLA-identical siblings. Nevertheless the use of matched unrelated donors should be considered for CML patients who lack HLA-identical siblings.
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PMID:Bone marrow transplantation for chronic myeloid leukemia: the use of histocompatible unrelated volunteer donors. 233 31

Data on 281 patients with chronic myelogenous leukemia who received bone marrow transplants were analyzed. The median follow-up time was 48 months. One hundred and seventy patients were in 1st chronic phase, 111 were in more advanced disease. The overall actuarial survival was 50% at 5 years. In multivariate analyses, the probability of relapse was correlated with the phase of the disease, the method of total body irradiation, the T cell depletion of the marrow and the occurrence of a chronic GVHD. The probability of disease free survival was significantly better for the patients who received a non T cell depleted marrow than for recipients of T cell depleted marrow. Bone marrow transplantion in first chronic phase with an HLA identical non T cell depleted marrow offers the better chance of prolonged leukemia free survival.
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PMID:Bone marrow transplantation for chronic myelogenous leukemia. Results of the French Cooperative Group (GEGMO). 234 85

In a multicenter study (seven University clinics) in the German Federal Republic bone marrow transplants from HLA-identical donors were performed in 177 patients (113 men, 64 women, mean age 32 [1.3-50] years) with Philadelphia chromosome-positive chronic myeloid leukaemia from 1982 to 1988. The survival rate among the 144 patients in whom the transplant had been carried out during the first chronic phase amounted to 58.4 +/- 11.4% after a median observation period of 3 years; survival rate among the 24 patients who underwent transplantation during the acceleration phase was 29.2 +/- 20.4%. All nine patients who received bone marrow transplants in the second chronic phase or during a blast crisis died during the period of observation (after median periods of 4 and 2 months, respectively). The most frequent causes of death among the group as a whole (82/177 patients) were interstitial pneumonia, acute and chronic graft versus host reactions (GVHD), recurrences and the toxic effects of previous treatment. The risk factors which significantly diminished survival rate were moderate to severe acute GVHD, chronic GVHD and age over 30 years.
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PMID:[Allogeneic bone marrow transplantation in chronic myeloid leukemia. The results of HLA-identical transplants in the Federal Republic of Germany]. 235 28

Twenty children with various hematological malignancies (nine with acute lymphoblastic leukemia, eight with acute non-lymphoblastic leukemia, two with chronic myelogenous leukemia, one with malignant lymphoma and one with 7-monosomy) and four with severe aplastic anemia were treated with allogeneic or syngeneic bone marrow transplantation (BMT) between September 1977 and September 1988. Eleven patients are surviving currently and ten are disease free 8 to 51 months after BMT. Conditioning regimen consisted of total body irradiation (TBI) and cyclophosphamide in twenty patients. Two patients did not receive TBI. Graft failure was observed in five patients and complete recovery of recipient marrow was seen in two of them. Eleven patients developed acute graft-versus-host disease (GvHD) with grade I-II in eight patients. Three patients suffered from chronic GvHD. Seven patients with acute leukemia relapsed and all but one died of leukemia. Early death occurred in two undergone BMT in poor clinical conditions. Performance status in 100% in surviving patients except one. Efforts to improve these results are that BMT should be considered early in the course of their disease for patients who are at risk for relapse with conventional chemotherapy and improved conditioning regimens to reduce leukemia relapse after BMT for patient with the second or subsequent remission.
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PMID:[Treatment results of bone marrow transplantation in Kyushu Cancer Center. Bone Marrow Transplantation Team]. 236 34

Between March 1983 and December 1985, six patients with haematological disorders (four acute nonlymphocytic leukaemias, one chronic phase chronic myeloid leukaemia and one severe aplastic anaemia have undergone allogeneic bone marrow transplantation. Four of the 6 patients are alive and free from disease between 33+ and 55+ months; two patients died due to grade IV acute graft versus host disease (GVHD).
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PMID:Preliminary experience with allogeneic bone marrow transplantation in haematological disorders in India. 238 13

A 32-year-old male patient with chronic myelocytic leukemia in accelerated phase received a bone marrow allograft from his 42-year-old HLA/MLC-identical sister. He recovered from acute graft-versus-host disease (GVHD) grade III-IV of skin, liver and gut, but chronic GVHD of progressive onset developed. On day 556 post-graft severe thrombocytopenia was resistant to prednisolone, cyclophosphamide and high dose immunoglobulin. Splenectomy was followed by a normalization of platelet counts. The subsequent clinical course was characterized by progressive muscular atrophy and weight loss. Dysphagia, dysarthria, cachexia and ultimately recurrent pneumonic episodes ensued. The cachectic patient developed a highly abnormal breathing pattern with hypoventilation and intermittent apnea requiring mechanical ventilation. Auditory evoked potentials revealed a considerable dysfunction of the brainstem. The patient died on day 1120 post-graft from pneumonia, aggravated by thoracic muscular insufficiency. Postmortem examination revealed diffuse predominantly lymphoid perivascular infiltration in meninges and CNS tissue; proliferation of activated microglial cells expressing the HLA-DR antigen was prominent in the brainstem. These histologic changes are similar to those observed in the CNS in experimental GVHD. We suggest that this case represents the first documentation of CNS involvement in chronic GVHD.
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PMID:Fatal encephalitis in a patient with chronic graft-versus-host disease. 239 Jun 33

We studied 2254 persons receiving HLA-identical sibling bone marrow transplants for acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL) in first remission, or chronic myelogenous leukemia (CML) in first chronic phase to determine whether graft-versus-leukemia (GvL) reactions are important in preventing leukemia recurrence after bone marrow transplantation. Four groups were investigated; recipients of non-T-cell depleted allografts without graft-versus-host disease (GvHD), recipients of non-T-cell depleted allografts with GvHD, recipients of T-cell depleted allografts, and recipients of genetically identical twin transplants compared with recipients of non-T-cell depleted allografts without GvHD, Decreased relapse was observed in recipients of non-T-cell depleted allografts with acute (relative risk 0.68, P = 0.03), chronic (relative risk, 0.43, P = 0.01), and both acute and chronic GvHD (relative risk 0.33, P = 0.0001). These data support an anti-leukemia effect of GvHD. AML patients receiving identical twin transplants had an increased probability of relapse (relative risk 2.58, P = 0.008) compared to allograft recipients without GvHD supporting an anti-leukemia effect of allografts independent of GvHD. CML patients receiving T-cell depleted transplants without GvHD had a higher probability of relapse (relative risk 6.91, P = 0.0001) than recipients of non-T-cell depleted allografts without GvHD. These data support an antileukemia effect independent of GvHD altered by T-cell depletion. These results indicate that much of the anti-leukemia effect of bone marrow transplants is related to immune factors rather than high-dose chemotherapy and/or radiation.
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PMID:Graft-versus-leukemia in bone marrow transplantation. The Advisory Committee of the International Bone Marrow Transplant Registry. 239 Jun 46

Between 1979 and 1986, 29 pediatric patients underwent bone marrow transplantation at Texas Children's Hospital using routine reverse isolation. Laminar air flow rooms, prophylactic antibiotics, and gut sterilization were not utilized. The diagnoses included acute lymphocytic leukemia (ALL) (16 patients), acute nonlymphocytic leukemia (ANLL) (10 patients), and chronic myelogenous leukemia (CML) (three patients). All patients had fever during hospitalization. There were 11 episodes of bacteremia in seven patients giving a bacteremia rate of 37.9%. Moderate-to-severe (grade II-IV) acute graft-versus-host disease (GVHD) was seen in eight patients (27.6%). The incidence of infection and GVHD during the first 100 days post-transplantation is comparable to published reports from centers utilizing rigid isolation and sterilization of the gut. It is suggested that bone marrow transplantation may be done using standard reverse isolation techniques without increasing the morbidity or mortality of the procedure.
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PMID:Bone marrow transplantation in childhood leukemia using reverse isolation techniques. 240 30

Bone marrow transplantation (BMT) after supralethal cytoreductive therapy in the acute leukemias, chronic myelogenous leukemia (CML), and the lymphomas may be curative in 50% to 60% of patients. The donor may be a human leukocyte antigen (HLA) matched family member (allogeneic), an identical twin (syngeneic), or the patient (autologous). In general, the outcome is best in younger patients and those transplanted early in their disease (i.e., in the first remission for acute leukemia and in the chronic phase of the disease in CML). Solutions to the major problems of allogeneic BMT, such as graft-versus-host disease and viral infections, are being actively pursued. Syngeneic and autologous BMT avoids some of the above problems, but relapses appear to be greater. Despite this problem, a significant number of cures have been accomplished. Newer methods of purging autologous marrow and newer preparative regimens promise to reduce the problem of relapses.
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PMID:Bone marrow transplantation in hematologic malignancies. Current status. 240 2


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