Autologous bone marrow transplantation for patients with relapsed Hodgkin's disease

Article Abstract:

Hodgkin's disease is often curable with radiotherapy and chemotherapy, and cure may even be possible after the failure of an initial chemotherapy regimen. However, a poor prognosis awaits patients with early relapse after complete remission; those who do not achieve remission with chemotherapy; and those who do not achieve remission even after more than one chemotherapy regimen. Autologous bone marrow transplantation (ABMT), a procedure in which previously removed and stored bone marrow is reinfused into a patient after extremely high doses of chemotherapy are given, is successful for treating many malignancies, but is often withheld until late in the course of Hodgkin's disease. To determine the optimal time for ABMT in relapsed Hodgkin's disease, 70 patients were studied who underwent this procedure after chemotherapy treatment with high-dose cyclophosphamide, carmustine, and etoposide. All patients had been treated with at least one previous chemotherapy regimen, and 29 had been treated with 3 or more. Forty percent of the patients had received radiotherapy as part of their initial treatment. Results showed that 59 percent of the patients who underwent ABMT achieved a complete remission; 11 percent responded partially; 19 percent did not respond; and 11 percent died. The 4-year disease-free survival was approximately 27 percent, and 4-year survival was approximately 47 percent. Patients treated earlier in the course of the disease fared significantly better than those in whom several chemotherapy regimens failed. High-dose chemotherapy plus ABMT appears more effective than salvage chemotherapy (another regimen begun after failure) for patients with relapsed Hodgkin's disease. This treatment should be carried out as soon as possible after relapse. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hodgkin's disease

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Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients

Article Abstract:

Lung complications are a major cause of increased illness and death in patients receiving high-dose chemotherapy and autologous bone marrow transplantation (ABMT), in which some of the patient's bone marrow is removed, treated, and then transplanted back into the patient. This combination of therapies has been used increasingly to treat patients with Hodgkin's disease (a malignant disorder of the lymph nodes and spleen), lymphoma and solid tumor malignancies. It has been observed recently that ABMT patients experience an abnormally high rate of lung hemorrhage, which is often fatal. To investigate the incidence of lung complications, 141 patients who had undergone ABMT were studied. Of these patients, 29 developed a syndrome characterized by dyspnea (shortness of breath), hypoxia (low levels of oxygen in the blood), cough and alveolar hemorrhage (bleeding in the small air sacs of the lung). The authors termed this syndrome 'diffuse alveolar hemorrhage' (DAH). The hemorrhages were diagnosed by bronchoscopy and by bronchioalveolar lavage, a process in which a saline solution is instilled into the lung and then aspirated out; hemorrhage is apparent from the excess blood found in the aspirated fluid. The presence of DAH has a serious effect on outcome; 23 of the 29 patients with DAH died, compared with a death rate of 14 out of 112 patients who did not have DAH. The study indicated that while there is no single characteristic to identify patients who are at high risk for DAH, the symptom complex occurred more often in patients over the age of 40 who had solid tumor malignancies. DAH usually became evident about 12 days after ABMT. It is also possible that kidney disorders and abnormally high white blood cell counts may enhance the likelihood of DAH.

Care and treatment, Injuries, Cancer, Cancer treatment, Pulmonary alveoli, Autografts

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Prevalence of clinically relevant bacteremia after upper gastrointestinal endoscopy in bone marrow transplant recipients

Article Abstract:

The prevalence of bacteremia, or bacterial infection of the blood, after upper endoscopy was assessed in 47 patients undergoing bone marrow transplantation. Endoscopy is the examination of a body cavity by use of a tube-like device fitted with an optical system. The patients required esophagastroduodenoscopy (EGD), or endoscopic examination of the esophagus, stomach, and first part of the small intestine, within 100 days after transplantation. The criteria for diagnosis of bacteremia included the development of hypotension (low blood pressure), temperature greater than 38.5 degrees Centigrade (101.3 deg F), and evidence of bacterial infection of the blood within 24 hours after endoscopy. The risk of bacteremia is increased by the development of graft-versus-host disease (GVHD), a pathological reaction between the transplant recipient's immune system and the transplanted tissue, and by treatment with the steroid prednisone to suppress the immune response. Bacteremia developed within 24 hours after endoscopy in nine patients, including eight of 14 patients treated with prednisone and one of 33 patients not receiving this drug. Six of 19 patients with GVHD at endoscopy also developed bacteremia. These findings show that prednisone treatment of GVHD after bone marrow transplantation increases the risk of developing bacteremia. Antibiotics should be given to prevent bacterial infection of the blood in bone marrow transplant recipients with GVHD who will be undergoing endoscopy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Drug therapy, Prednisone, Bacteremia, Graft versus host reaction, Graft vs. host disease, Endoscopy

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