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Selected complications of allogeneic bone marrow transplantation.
Wujcik D, Ballard B, Camp-Sorrell D
(1994) Semin Oncol Nurs 10: 28-41
MeSH Terms: Acute Kidney Injury, Bacterial Infections, Bone Marrow Transplantation, Graft vs Host Disease, Hepatic Veno-Occlusive Disease, Humans, Immunosuppression, Risk Factors
Show Abstract · Added March 27, 2014
Patients receiving allogeneic bone marrow transplant experience multiple complications. Specifically, infection, renal complications, VOD, and GVHD can produce life-threatening toxicity. Many of the treatments cause further compromise of major organs. Astute nursing assessment and prompt interventions can decrease the severity experienced by the patient. Each of these complications requires ongoing study to develop new therapies for management.
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8 MeSH Terms
Pathology of the pancreas in severe combined immunodeficiency and DiGeorge syndrome: acute graft-versus-host disease and unusual viral infections.
Washington K, Gossage DL, Gottfried MR
(1994) Hum Pathol 25: 908-14
MeSH Terms: Bone Marrow Transplantation, Child, DiGeorge Syndrome, Female, Graft vs Host Disease, Humans, Immunoenzyme Techniques, Infant, Infant, Newborn, Male, Pancreas, Pancreatitis, Severe Combined Immunodeficiency, Virus Diseases
Show Abstract · Added April 12, 2016
Review of autopsies of 28 children with severe combined immunodeficiency (SCID) or combined immunodeficiency (CID) and three with DiGeorge syndrome showed a high incidence of acute graft-versus-host disease (GVHD) in the pancreas. Acute GVHD (seven cases: four SCID, two CID, and one DiGeorge syndrome) was characterized by lymphocytes around large to medium ducts, damage to ductal epithelium (focal necrosis, reactive nuclear changes, inspissated secretions in duct lumens), and periductal edema. Changes were judged indeterminate but suspicious for GVHD when ductal damage was slight (six cases: three SCID, two CID, and one DiGeorge syndrome). All patients with pancreatic GVHD had received allogeneic bone marrow, fetal liver or thymus transplant, or nonirradiated blood products and had evidence of GVHD in other organs. Immunoperoxidase stain for HLA-DR showed strong-to-moderate staining of duct epithelium in two of four GVHD cases for which blocks were available. This change was nonspecific; weaker staining for HLA-DR was seen in cases with nonspecific abnormalities and in viral pancreatitis. Four cases had histological evidence of viral infection: two had cytomegalovirus pancreatitis, one had patchy parenchymal necrosis caused by adenovirus, and one had giant cell pancreatitis caused by parainfluenza virus. Mild nonspecific changes, such as focal fat necrosis or acinar dilatation, were seen in seven cases. One case had unexplained marked pancreatic atrophy and fibrosis. Acute pancreatic GVHD is not uncommon in autopsies of children with congenital immune deficiencies with GVHD of other organs; however, this finding may not have strong clinical implications in this group of patients. Careful attention to pancreatic ducts is necessary for diagnosis. Unusual viral pancreatitis may also be seen in this group, as well as nonspecific abnormalities.
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14 MeSH Terms
Graft-versus-host-disease prophylaxis for matched unrelated donor bone marrow transplantation: comparison between cyclosporine-methotrexate and cyclosporine-methotrexate-methylprednisolone.
Leelasiri A, Greer JP, Stein RS, Goodman S, Brandt SA, Edwards JR, Wolff SN
(1995) Bone Marrow Transplant 15: 401-5
MeSH Terms: Adolescent, Adult, Bone Marrow Transplantation, Child, Child, Preschool, Cyclosporine, Drug Therapy, Combination, Female, Graft vs Host Disease, Histocompatibility, Humans, Incidence, Infections, Male, Methotrexate, Methylprednisolone, Survival Rate
Show Abstract · Added March 5, 2014
We performed a sequential study comparing two regimens, cyclosporine-methotrexate (CsA-MTX) and cyclosporine-methotrexate-methylprednisolone (CsA-MTX-MP) for graft-versus-host disease (GVHD) prophylaxis in patients undergoing matched unrelated donor bone marrow transplantation (MUD BMT). Study end-points were the development of GVHD, various infectious complications and survival. Twenty nine patients with malignant hematologic disease without HLA-compatible family donors were treated between May 1990 and November 1993. All donors were volunteers from the National Marrow Donor Program (NMDP) serologically HLA-A-A, B and DR identical. MLC reactivity and high resolution DR DNA typing were not used to exclude donors. Sixteen patients received CsA-MTX and 13 patients received CsA-MTX-MP. CsA and MTX doses were the same in both groups: CsA 1.5 mg/kg i.v. over 2h every 12h beginning the day prior to transplant (day-1) and MTX 10 mg/m2 i.v. bolus on days +1, +3 and +6 with leucovorin on days +2, +4 and +7. MP was administered at a dose of 0.25 mg/kg i.v. every 12h beginning on day +7 and increased to 0.5 mg/kg on day +14. Beginning on day +35 MP and CsA were tapered 5% per week with targeted discontinuation at 6 months. Both groups were comparable for primary disease, preparative regimen, recipient age (median 33 VS 33 years), donor age (median 39 vs 39.5 years), donor-recipient sex, donor ABO mismatch and serologic CMV positivity. All patients received similar supportive care.(ABSTRACT TRUNCATED AT 250 WORDS)
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17 MeSH Terms
Late infections after allogeneic bone marrow transplantations: comparison of incidence in related and unrelated donor transplant recipients.
Ochs L, Shu XO, Miller J, Enright H, Wagner J, Filipovich A, Miller W, Weisdorf D
(1995) Blood 86: 3979-86
MeSH Terms: Adolescent, Adult, Bone Marrow Transplantation, Child, Disease Susceptibility, Family, Female, Follow-Up Studies, Graft vs Host Disease, Histocompatibility, Humans, Immunocompromised Host, Incidence, Infection Control, Infections, Life Tables, Male, Middle Aged, Minnesota, Multivariate Analysis, Proportional Hazards Models, Risk, Survival Analysis, Time Factors, Tissue Donors, Transplantation, Homologous
Show Abstract · Added December 10, 2013
Infectious complications are a major cause of morbidity and mortality after allogeneic bone marrow transplantation (BMT). We have evaluated the incidence of late infections (beyond day +50) in recipients of related (RD) and unrelated donor (URD) allogeneic BMT, factors associated with increased risks of infection, and the impact of the late infections on survival. Between 1989 and 1991, 249 patients received an RD (n = 151) or URD (n = 98) allogeneic BMT at the University of Minnesota and all late infections were investigated. Three hundred sixty-seven late infectious events developed in 162 patients between 50 days and 2 years after BMT. The incidence of any late infection was greater in URD versus RD recipients (84.7% v 68.2%, respectively; P = .009). In multivariate analysis, advanced graft-versus-host disease (GVHD) was significantly associated with late infections. The effect of GVHD was apparent only in RD recipients (relative risk [RR], 2.29; P = .003), whereas URD recipients, with or without GVHD, had more late infections compared with RD recipients without GVHD. Multivariate analysis showed that late posttransplantation infections were the dominant independent factor associated with increased nonrelapse mortality (RR, 5.5; P = .0001), resulting in improved 3-year survival for RD versus URD recipients (49.9% +/- 8% v 34.4% +/- 10%; P = .004). In this study, we observed that late infections are more frequent in URD recipients, resulting in substantially higher nonrelapse mortality. This prolonged period of increased infectious risk in URD recipients suggests the need for aggressive surveillance and therapy of late infections and perhaps prolonged antibiotic prophylaxis for all URD BMT recipients.
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26 MeSH Terms
Epstein-Barr virus lymphoproliferation after bone marrow transplantation.
Zutter MM, Martin PJ, Sale GE, Shulman HM, Fisher L, Thomas ED, Durnam DM
(1988) Blood 72: 520-9
MeSH Terms: Acyclovir, Adolescent, Adult, Bone Marrow Transplantation, Child, Child, Preschool, Genes, Immunoglobulin, Graft vs Host Disease, Herpesviridae Infections, Herpesvirus 4, Human, Humans, Lymph Nodes, Lymphoproliferative Disorders, Risk Factors
Show Abstract · Added February 16, 2014
We review 15 cases of secondary B-cell lymphoproliferative disorders that occurred among 2,475 patients who received allogeneic bone marrow transplants (BMTs) at the Fred Hutchinson Cancer Research Center (Seattle) between 1969 and 1987. The histopathologic findings in 14 of the 15 patients spanned a wide spectrum of lymphoproliferative lesions. One patient had features characteristic of angioimmunoblastic lymphadenopathy. Epstein-Barr virus (EBV) genomic sequences were identified by Southern blot analysis in each of the 13 patients evaluated. Ten of the 12 lesions evaluated originated in donor cells. In two patients, who had mixed chimerism after transplantation, the lesions originated in host cells. The combined evidence from immunoglobulin light chain staining and the analysis of immunoglobulin heavy chain gene rearrangement indicated that the lesions in most patients represented polyclonal proliferations that gave rise to clonal subpopulations. The results indicate an overall actuarial incidence of 0.6% for this complication in BMT recipients. Anti-CD3 monoclonal antibody (MoAb) treatment of acute graft-v-host disease (GVHD) and T cell depletion of the donor marrow were statistically significant risk factors, and GVHD appeared to play a contributing role, particularly in the setting of human leukocyte antigen (HLA) disparity. Two patients had no identifiable risk factors. Prophylaxis or treatment with acyclovir had no detectable effect in the patients; all but two died with uncontrolled lymphoproliferation.
1 Communities
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14 MeSH Terms
Secondary T-cell lymphoproliferation after marrow transplantation.
Zutter MM, Durnam DM, Hackman RC, Loughran TP, Kidd PG, Ashley RL, Petersdorf EW, Martin PJ, Thomas ED
(1990) Am J Clin Pathol 94: 714-21
MeSH Terms: Adolescent, Antigens, Surface, Blotting, Southern, Bone Marrow Transplantation, Child, Child, Preschool, Female, Gene Expression, Gene Rearrangement, T-Lymphocyte, Graft vs Host Disease, HIV, Herpesvirus 4, Human, Humans, Immunosuppressive Agents, Lymphoma, T-Cell, Male
Show Abstract · Added February 16, 2014
Secondary lymphoproliferative syndromes in immunosuppressed patients have been characterized as polyclonal or monoclonal B-lineage disorders nearly always associated with Epstein-Barr virus (EBV) infection. The authors now report three patients with a distinctly different lymphoproliferative syndrome. Two patients with common acute lymphoblastic leukemia antigen (CALLA) (CD10)-positive acute lymphoblastic leukemia and one patient with acute myelogenous leukemia, respectively, received high-dose chemoradiotherapy followed by marrow transplantation from either an HLA-identical sibling or HLA-mismatched parent. All three patients developed severe graft-versus-host disease (GVHD), requiring immunosuppressive treatment with corticosteroids. A secondary malignant T-cell lymphoproliferation occurred 2, 21, and 43 months, respectively, after marrow transplantation. In all three cases the lymphoid cells expressed T-cell surface antigens and were morphologically and immunophenotypically distinct from the malignant cells present before transplantation. One tumor was of host cell origin, one was probably of donor origin, and the tumor origin in the third case could not be determined. The authors were unable to find any evidence for EBV, human T-cell lymphotropic virus type I or II, human immunodeficiency virus, or human herpesvirus 6.
1 Communities
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16 MeSH Terms
The graft versus leukemia effect: possible mechanisms and clinical significance to the biologic therapy of leukemia.
Sosman JA, Sondel PM
(1991) Bone Marrow Transplant 7 Suppl 1: 33-7
MeSH Terms: Animals, Bone Marrow Transplantation, Combined Modality Therapy, Graft vs Host Disease, Graft vs Host Reaction, Humans, Immunotherapy, Interleukin-2, Leukemia
Show Abstract · Added March 5, 2014
An anti-leukemic effect of allogeneic bone marrow has been repeatedly demonstrated in experimental animal models. Clinical data supporting this "graft versus leukemia" (GVL) effect are derived from several different observations which include: 1) the association of GVHD (acute and chronic) with decreased leukemic relapses; 2) identical twin transplants are associated with a higher relapse rate compared to allogeneic MHC-matched sibling transplants; 3) T cell depletion of donor bone marrow decreases GVHD and increases leukemic relapse rates; 4) Allogeneic BMT without GVHD have a lower leukemic relapse rate compared to identical twin transplants and T cell depleted transplants. The mechanisms of this GVL effect remain poorly understood, but clearly involve the immune system. It is hoped that current advances in basic understanding of the immune system and its activation will enable the "antileukemic" components of the GVL effect to be prospectively controlled and intentionally used as leukemia therapy.
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9 MeSH Terms
Bone marrow transplantation.
Wujcik D, Downs S
(1992) Crit Care Nurs Clin North Am 4: 149-66
MeSH Terms: Bone Marrow Transplantation, Graft vs Host Disease, Humans, Nursing Diagnosis, Postoperative Care, Preoperative Care
Show Abstract · Added March 27, 2014
BMT is an effective treatment for certain malignant and nonmalignant conditions. The source of the marrow is autologous or allogeneic. An allogeneic donor can be an HLA-matched related or unrelated donor. The patient undergoes intense chemoradiotherapy to remove remaining malignant cells and obliterate the immune system, thus allowing growth of the new bone marrow cells. Complications of conditioning therapy include pancytopenia and distinct organ toxicities. Astute nursing care is critical in managing the care of BMT patients. Assessment and numerous, interrelated interventions are required. Late complications of BMT relate to the conditioning therapy and to the transplant itself. As BMT becomes more readily available as a treatment, economic issues related to the cost of care and the allocation of resources challenge health care providers.
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6 MeSH Terms