Immunomodulatory and antimicrobial efficacy of intravenous immunoglobulin in bone marrow transplantation

Article Abstract:

After patients undergo bone marrow transplantation to treat aplastic anemia (a decrease in the number of blood cells) malignancies, or other conditions, they must take drugs and other treatments that suppress their immune systems so that the transplanted marrow will not be rejected. However, immunosuppression often results in infection by cytomegalovirus (CMV) and other agents, interstitial pneumonia, graft-versus-host disease (GVHD), and in some cases results in death. GVHD occurs when the donor cells attack host tissue. However, it is possible that administration of immunoglobulins (antibodies) can improve the prognosis for marrow transplant patients. To evaluate this, a randomized study of 382 bone marrow recipients was carried out; 191 received immunoglobulin, and 191 controls did not receive immunoglobulin. After undergoing treatment with immunosuppressant drugs and radiation therapy (if indicated for malignancy), patients received bone marrow on day zero. This was followed by immunosuppressant treatment. Immunoglobulin treatment took place on a weekly basis from day seven before transplantation until day 90 afterwards, then monthly until day 360. A strict regimen of supportive care was followed, and patients were evaluated for the presence or absence of cytomegalovirus (seropositivity or -negativity, respectively). Results showed that patients who received immunoglobulin had higher levels of immunoglobulin G (the main immunoglobulin). Virtually all patients in the control group who were seronegative for CMV and who received blood products from seropositive people remained seronegative; but seronegative patients in the immunoglobulin group who received screened blood became seropositive. Patients who received immunoglobulin had a lower incidence of GVHD, interstitial pneumonia, septicemia (bacteria in the bloodstream), and local infections. Sixty-nine control patients and 66 immunoglobulin patients survived until follow-up at two years' time. Neither survival nor the risk of relapse was affected by the immunoglobulin treatments. Overall, it appeared that the early complications of bone marrow transplantation were reduced in severity and frequency by immunoglobulin treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Pneumocystis carinii pneumonia, Immunoglobulins, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Cytomegaloviruses, Cytomegalovirus

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Graft-versus-host disease as adoptive immunotherapy in patients with advanced hematologic neoplasms

Article Abstract:

Graft-versus-host-disease (GVHD) can occur after allogenic transplantation (donor is usually a close relative) of bone marrow to a host (patient) in the treatment of leukemia. It is thought that GVHD may actually decrease the likelihood that the patient will have a recurrence of disease. This effect is known as "adoptive immunotherapy"; cells from the bone marrow of the donor recognize and destroy malignant cancer cells in the host, resulting in a "graft-versus-leukemia" effect. A study was conducted to determine whether the antileukemic effect of GVHD could be enhanced to improve long-term survival among patients with advanced leukemia. The patients selected had received allogenic bone marrow transplants, were under 30 years of age (less likely to develop severe GVHD) and had a high risk of cancer recurrence. Three different types of treatment regimens to suppress the immune system (i.e., drugs given to prevent graft rejection) were administered: methotrexate for 102 days (Group I); methotrexate for 11 days (Group II); and methotrexate plus buffy-coat cells (white blood cells and platelets from centrifuged donor blood samples) for 102 days (Group III). GVHD occurred in 25 percent of the patients in Group I, 59 percent of Group II, and 82 percent of Group III. The incidence of chronic GVHD and the five-year probability of survival did not differ among the three groups. Non-cancer related deaths were due to infections complicated by GVHD. Researchers conclude that shortening the period of methotrexate administration or infusing buffy-coat cells increased the incidence of GVHD and related mortality, but did not effect the incidence of chronic GVHD or cancer recurrence. It is speculated that chronic GVHD accompanied by clinical symptoms may be required for a graft-versus-leukemia effect.

Research, Physiological aspects, Dosage and administration, Leukemia, Immunosuppressive agents, Methotrexate, Immunotherapy

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Secondary cancers after bone marrow transplantation for leukemia or aplastic anemia

Article Abstract:

Secondary cancers can develop as a result of treatments used for other diseases, such as chemotherapy and radiation used to treat primary cancers and immunosuppression disorders and to minimize transplant rejection. Bone marrow, which produces blood cells, is transplanted in patients having abnormal blood cell production in an attempt to restore normal blood cell production. Leukemia, a cancer in which there is an abnormal production of immature white blood cells, and aplastic anemia, a disease affecting abnormal red blood cell production, are treated with bone marrow transplants. Patients with leukemia may receive total body irradiation and chemotherapy and patients with aplastic anemia may be given chemotherapy. To determine the risk of developing a secondary cancer after bone marrow transplant, 1,926 leukemia patients and 320 aplastic anemia patients were evaluated. Secondary cancers such as non-Hodgkins lymphoma, other leukemias, and solid tumors developed in 35 patients. Patients having graft-versus-host reactions to transplanted tissue or total body irradiation had a higher incidence of secondary cancers. Although the incidence of secondary cancer is low, it is suggested that an effort should be made to prevent graft-versus-host reactions by matching bone marrow donors and recipients for tissue compatibility and to avoid total body irradiation in patients having bone marrow transplants for non-cancerous blood diseases such as aplastic anemia.

Diagnosis, Hodgkin's disease, Cancer, Cancer diagnosis

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