Bone marrow transplantation
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Bone Marrow Transplant. · Mar 1994
Varicella zoster infection after bone marrow transplantation: incidence, risk factors and complications.
The cellular immunoincompetence which follows bone marrow transplantation (BMT) allows both primary and reactivation infection with herpes viruses. We report the overall incidence and timing of varicella zoster virus (VZV) infections after BMT, including the clinical course, complications and associated clinical risk features. Of 1186 patients undergoing BMT through 1989, 216 patients developed VZV infection between 4 days and 10.8 years after BMT; 86% of them within the first 18 months. ⋯ Age > or = 10 years and radiation in the pre-transplant conditioning were significantly and independently associated with higher rates of VZV infection within a multivariate regression model. Using this model, we could define clinical risk groups with distinctly different hazards of VZV infection: age > 10 years, radiation pre-BMT and VZV seropositive patients had a 44% incidence by 3 years versus age < 10 years, no radiation and VZV seronegative had a 0% incidence by 3 years. Acyclovir assigned for prophylaxis of CMV or HSV infection had no effect on the timing or incidence of VZV infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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Bone Marrow Transplant. · Feb 1994
Randomized Controlled Trial Clinical TrialEffect of pentoxifylline on regimen related toxicity in patients undergoing allogeneic or autologous bone marrow transplantation.
An unblinded, historical controlled study of 49 bone marrow transplant (BMT) patients was carried out in our institution to assess the effect of oral pentoxifylline (PTX) on BMT regimen related toxicity (RRT). Twenty-eight consecutively treated BMT patients (17 allogeneic, 11 autologous) were entered into the PTX treatment group and treated with oral PTX 400 mg at intervals of 4 h from day -10 until day +35 or discharge, whichever came sooner. These were compared with a control group of 21 BMT patients (14 allogeneic, 7 autologous). ⋯ Despite this, no significant difference in days of mucositis or hyperalimentation, incidence or severity of renal or hepatic dysfunction, hypertension, GVHD, weight gain > 5%, day 100 mortality or length of hospitalization was observed. Median follow-up is > 2 years in both groups and no difference in relapse or survival was observed. We were unable to confirm an effect of oral PTX on BMT related morbidity or mortality.
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Bone Marrow Transplant. · Feb 1994
Case ReportsBronchiolitis obliterans organizing pneumonia (BOOP) in children after allogeneic bone marrow transplantation.
Three pediatric patients of a cohort of 24 who underwent allogeneic bone marrow transplantation (BMT) from matched unrelated or mismatched family member donors developed low grade fever and cough between 2 and 3 months after BMT in the absence of clinical GVHD. Imaging studies revealed bilateral patchy opacities and open lung biopsies revealed the characteristic histological appearance of bronchiolitis obliterans organizing pneumonia. All three patients were treated with steroids and in two patients the syndrome resolved over 1-2 months; the third patient developed progressive pulmonary failure and died 2 weeks after diagnosis. BOOP may be an under-recognized respiratory complication following BMT from a matched unrelated donor or mismatched family member.
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Bone Marrow Transplant. · Jan 1994
Review Randomized Controlled Trial Clinical TrialRole of etoposide (VP-16) in preparatory regimens for patients with leukemia or lymphoma undergoing allogeneic bone marrow transplantation.
In 1983, we began a series of clinical trials with the goal of reducing the relapse rate following allogeneic BMT for hematologic malignancies. Because of its anti-leukemic activity, the drug VP-16 was chosen and combined with total body irradiation (TBI). The first series (trial I) consisted of patients who had advanced leukemia. ⋯ Since the regimen-related toxicity has been relatively low, we have added one dose of CY 60 mg/kg to the FTBI/VP-16 combination. This regimen (trial V) is currently being tested in patients with advanced leukemia. The preliminary results of this ongoing trial indicate further improvement in disease-free survival through a reduction of the post-transplant relapse rate.
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Respiratory failure is the main cause of death in patients undergoing bone marrow transplantation (BMT). In this paper, clinical and research aspects as well as diagnostic, prophylactic and therapeutic strategies concerning the various forms of pulmonary and bronchial complications, which may evolve after BMT, are discussed. Both cytomegalovirus (CMV)-induced interstitial pneumonia (PM) and the idiopathic pneumonia syndrome rarely occur in the cytopenic phase post-BMT. ⋯ Venous thromboembolism or air embolism may occur; they are usually venous catheter-associated. Pleural effusions may develop secondary to infection, congestive heart failure, veno-occlusive disease, pulmonary embolism or malignancy. Patients with bronchiolitis obliterans, which leads to progressive respiratory failure, present with an obstructive pattern in lung function tests and hyperinflated lungs on chest radiographs.(ABSTRACT TRUNCATED AT 400 WORDS)