Allogeneic bone marrow transplantation, zidovudine, and human immunodeficiency virus type 1 (HIV-1) infection

Article Abstract:

Non-Hodgkin lymphoma in an HIV-infected patient is sufficient for a diagnosis of AIDS. Bone marrow transplantation may be a successful therapeutic option for patients with a poor prognosis. In the case of a 41-year-old HIV-infected man with non-Hodgkin lymphoma, bone marrow transplantation with chemotherapy and whole body irradiation seems to have eradicated the human immunodeficiency virus prior to the man's death from the tumor. The patient received high-dose zidovudine, 5mg per Kg of body weight intravenously every four hours, for two weeks prior to the transplant. His lymphoma had previously been treated with cyclophosphamide and whole body irradiation. After bone marrow transplantation, the patient was maintained on zidovudine at 1.33mg per Kg rather than 5mg. After the patient died, 47 days following surgery, analysis of tissue specimens obtained at autopsy revealed no HIV, either by culture growth from lymph nodes, brain, bone marrow, or tumor specimens, or by polymerase chain reaction (PCR) gene amplification of HIV gene sequences from numerous organs. PCR is capable of amplifying exquisitely small traces of genes into detectable amounts, so it is thought that the negative test indeed represented an elimination of the virus from the patient. Possibly, most HIV-positive cells were eliminated by the radiation and chemotherapy, and the zidovudine may have prevented HIV infection of the donor bone marrow. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Case studies, AIDS (Disease), Zidovudine

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Health, functional status, and employment of adult survivors of bone marrow transplantation

Article Abstract:

As therapy for cancer has progressed from merely relieving pain to, in some cases, providing a cure, the after effects of treatment must be examined. Bone marrow transplantation is now used more frequently to treat hematologic malignancies (cancers of the blood) and bone marrow failure, such as aplastic anemia. One hundred fifty-seven bone marrow recipients were surveyed to assess 'quality-of-life' issues, such as patient perception of the state of his health, pain, employment, and job discrimination. Out of a total of 135 responses that were received, 93 percent reported that they were able to function without or with only minor physical limitations. Most patients reported their health, physical functioning, and social functioning as good or excellent. Physician assessment of patient health generally correlated with patient reports. A total of 65 percent were employed after their transplant, but the same percentage also reported that job plans had been affected by their illness. Ten percent reported significant levels of job discrimination. Generally, bone marrow transplant survivors reported good health, and functioned well in their jobs and in social settings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Measurement, Complications and side effects, Quality of life, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation

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Thalidomide for the treatment of chronic graft-versus-host disease

Article Abstract:

Thalidomide may be an effective and safe treatment for patients with chronic graft-versus-host disease (GVHD). Chronic GVHD occurs in patients who receive bone marrow transplants, and high-risk chronic GVHD can cause death. Among 44 patients with chronic GVHD who were treated with oral thalidomide, 23 had refractory GVHD, or GVHD that did not respond to conventional treatment, and 21 had high-risk GVHD. Twenty-eight patients (64%) survived; 18 (78%) with refractory GVHD and 10 (48%) with high-risk GVHD. Fourteen patients (32%) had complete recovery after treatment, 12 patients (27%) had partial recovery after treatment, and 18 patients (41%) had no response to treatment. The major side effects were sleepiness, which occurred in 91% of the patients, and constipation, which occurred in half the patients.

Health aspects, Graft versus host reaction, Graft vs. host disease, Thalidomide

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