Obstructive lung disease after allogeneic marrow transplantation

Article Abstract:

The clinical symptoms and progression of obstructive lung disease that occurred 50 days or more after bone marrow transplantation were examined in 35 out of 1,029 patients who received bone marrow transplants. Bone marrow transplantation has been successfully used to treat leukemia and aplastic anemia, but complications such as infections of the lungs can occur. Of the patients who developed lung disease, 95 percent of the cases developed within one and one-half years of the transplantation procedure. The time of onset, the severity, and the rate of progression of the lung disease varied among the patients. The symptoms included cough, shortness of breath, difficulty breathing, and wheezing. For 80 percent of the patients, chest X-rays were normal. Immune rejection of the bone marrow transplant, known as graft-versus-host disease, was seen in 24 (69 percent) of the patients, of whom only four responded completely to treatment. The mechanism of the lung disease seems to be immunological, since it is associated with graft-versus-host disease. Concentrations of immunoglobulins (antibodies) in the blood were decreased in some of the patients. At three years after transplant, mortality was 65 percent among patients with graft-versus-host disease and lung disease, which was significantly higher than the 44 percent mortality seen among the patients with graft-versus-host disease but normal lung function. Therefore, obstructive lung disease can be a serious, often fatal complication of bone marrow transplantation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Lung diseases, Obstructive, Chronic obstructive lung disease, Graft versus host reaction, Transplantation immunology, Graft vs. host disease

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Ganciclovir prophylaxis of cytomegalovirus infection and disease in allogeneic bone marrow transplant recipients: results of a placebo-controlled, double-blind trial

Article Abstract:

Taking the drug ganciclovir before and after bone marrow transplantation appears to lower the risk and severity of cytomegalovirus (CMV) infection in CMV-seropositive patients. CMV infection, which can cause pneumonia, fever, wasting, hepatitis and even death, frequently develops after bone marrow transplants. Of 45 CMV-seropositive patients who took a placebo, or inactive substance, before and after marrow transplant, 25 (56%) developed CMV infection compared with eight of 40 patients (20%) who took ganciclovir before and after transplant. Furthermore, CMV disease - pneumonia, gastroenteritis or wasting syndrome - developed in only 10% of the patients taking ganciclovir compared with 24% of the patients taking gancyclovir. Of the patients taking ganciclovir however, 58% had to interrupt treatment because of neutropenia, which is a decrease in the number of white blood cells known as neutrophils, compared with 28% of the patients taking placebo. Most patients taking ganciclovir were eventually able to resume treatment at either the same or a lower dose.

Prevention, Cytomegalovirus infections, Ganciclovir

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Corticosteroid therapy for diffuse alveolar hemorrhage in autologous bone marrow transplant recipients

Article Abstract:

A new syndrome of diffuse hemorrhage of the alveoli (air cells of the lung) has been described in certain patients who underwent autologous bone marrow transplant, in which their own marrow was harvested and then replanted after the marrow was treated for the underlying disease. Diffuse alveolar hemorrhage carries an 80 percent mortality and is associated with risk factors such as age (over 40 years), other tumors, high fever, and kidney insufficiency. Out of 77 patient with lymphoma who received autologous bone marrow transplants, four developed this syndrome. The four patients were treated with high doses of the steroid methylprednisolone, and all ultimately recovered from alveolar hemorrhage. Three were alive at the time of this report, and one patient died of graft-versus-host disease. Recovery from diffuse alveolar hemorrhage appears to be enhanced by timely diagnosis accompanied by high-dose steroid therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Risk factors, Drug therapy, Corticosteroids, Adrenocortical hormones, Hemorrhage

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