Autotransplantation in lymphoma: better therapy or healthier patients?

Article Abstract:

One of the newer therapies for large-cell lymphoma (a malignancy of lymphoid tissue that affects blood cells) in patients who are not in chemotherapy is autotransplantation, in which the patient's bone marrow is "harvested," or removed and stored. The patient then undergoes very high-dose chemotherapy or high levels of radiation therapy to destroy the remaining cancer cells. These high doses also destroy the remaining marrow, the source of normal red and white blood cells. The harvested marrow is then reimplanted, with the hope that the blood cells will be regenerated, allowing the patient to survive both the cancer and its treatment. Results from several studies now indicate that 20 percent of the patients experience a 2-year period during which they are free of disease, a far greater proportion than the 5 percent reported for patients treated with conventional therapies. Is autotransplantation a better therapy, or are the patients selected for this procedure simply less ill when selected? Autotransplantation candidates are generally younger, responding to chemotherapy, in remission at the time of referral (no signs of disease), and less likely to have evidence of bone marrow disease. Although the effectiveness of autotransplantation apart from patient selection factors cannot be proven, it is likely that it does, indeed, confer benefits. The evidence to support this viewpoint is briefly reviewed. Autotransplantation should probably not be used as an initial treatment, because chemotherapy alone produces remissions in 80 percent of the patients. The timing of the procedure with respect to chemotherapy and disease progression is important, too, but many issues concerning timing remain to be resolved. It is also possible that autotransplantation is not necessary, and that patients could be subjected to intense chemotherapy and radiation, then placed in protected environments and given drugs to enhance their production of blood cells. More assessment and study are needed to determine the usefulness of autotransplantation for treating lymphoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Stem cells, Stem cell transplantation, Lymphomas, Blood transfusion, Autologous, Autologous blood transfusion, Autografts

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Clinical uses of intravenous immunoglobulins

Article Abstract:

A review of the clinical uses of immunoglobulins, or antibody molecules, was compiled from articles and reports published from 1982 to 1989. Information about the patients, the clinical situations, the intervention used, and the outcome of the intervention was assessed. There have been few controlled, randomized clinical trials conducted on the use of intravenous immunoglobulin. However, intravenous immunoglobulin is safe and effective in treating patients with the following conditions: primary immune deficiency, where the patients cannot make their own immunoglobulin molecules and are susceptible to infection with various bacteria and viruses; premature infants who have lower levels of immunoglobulins than adults, especially those at risk for group B streptococcus infection; patients, primarily young children, with Kawasaki disease or mucocutaneous lymph node syndrome; patients who have received an organ transplant and are at risk for infection with cytomegalovirus, which causes a pneumonia; patients with idiopathic thrombocytopenic purpura, which is an autoimmune disease that results in low numbers of blood platelets; and some patients with chronic lymphocytic leukemia, who do not have normal levels of immunoglobulins. There is less convincing evidence concerning the value of immunoglobulins to prevent infection in patients with burns, surgery, and trauma. The use of intravenous immunoglobulins may be beneficial in the treatment of other disorders and diseases, such as rheumatoid arthritis, systemic lupus erythematosus, AIDS (acquired immunodeficiency syndrome), multiple myeloma, and lymphomas. However, more research will be necessary to test the efficacy of intravenous immunoglobulins in these disease states. (Consumer Summary produced by Reliance Medical Information, Inc.)

Immunological deficiency syndromes, Immunologic deficiency syndromes, Gamma globulins, Globulin, Globulins

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Incidence of hepatitis C in patients receiving different preparations of hepatitis B immunoglobulins after liver transplantation

Article Abstract:

Liver transplant recipients in France may have benefitted from hepatitis B immunoglobulins in more ways than one. These immunoglobulins are given to transplant patients to prevent them from developing hepatitis B after the transplant. Until March, 1990, people who donated immunoglobulins were not tested for hepatitis C virus. Among 428 liver transplant recipients, researchers found that those who received immunoglobulins before March, 1990 had a much lower risk of developing hepatitis C than those who did not receive immunoglobulins. Thus, the immunoglobulins must have contained antibodies against hepatitis C virus.

Prevention, Organ transplant recipients, Hepatitis C, Liver, Liver transplantation

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