Immunologic purging of marrow assessed by PCR before autologous bone marrow transplantation for B-cell lymphoma

Article Abstract:

One of the factors limiting the dosage of chemotherapeutic agents is bone marrow toxicity. To permit the use of greater and more effective doses of chemotherapy, it is possible to remove some of the patient's own bone marrow and replace it following the chemotherapeutic treatment, thereby providing new cells to recolonize the marrow destroyed by the drug treatment. However, for some conditions, such as lymphoma, there is concern that the bone marrow itself may contain tumor cells, and thus the autologous replacement of the patient's own marrow may lead to a relapse. Techniques have been developed to permit the purging of tumor cells from the bone marrow prior to replacement. However, the evaluation of this technique is hampered by the difficulty of determining whether a few tumor cells are indeed present among the myriad of bone marrow cells. Researchers have now applied the sensitive polymerase chain reaction (PCR) to this problem. PCR was used before and after bone marrow purging to identify residual lymphoma cells in 114 patients. These patients all had a B-cell non-Hodgkin's lymphoma with a chromosomal abnormality; it is this abnormality that permitted the PCR technique to detect the small numbers of lymphoma cells scattered among the normal bone marrow cells. The purging procedure reduced the number of lymphoma cells in the bone marrow from one thousand to one million times. In 57 cases, no lymphoma cells were detected following the purging procedure. Only four cases relapsed among these 57 cases. Among the remaining 57 patients who experienced a reduction but not an elimination of lymphoma cells, there were 26 relapses. Two important conclusions follow from these results. Successful purging results in a significant increase in the freedom from relapse. Furthermore, tumor cells in the transplanted bone marrow significantly contribute to the likelihood of relapse. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Polymerase chain reaction, Lymphomas

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Multiple organ dysfunction syndrome in bone marrow transplantation

Article Abstract:

Single organ dysfunction in bone marrow transplantation appears to indicate a systemic dysfunction that can lead to multiple organ dysfunction syndrome (MODS) and death. Researchers studied 199 patients admitted to a hospital for bone marrow transplantation. Ninety-three (48.5%) of the patients had a single dysfunction of the pulmonary, central nervous, or hepatic system that strongly predicted MODS. Fourteen patients died during the transplantation, 10 of multiple organ failure. Low levels of naturally occurring anticoagulants, protein C (PC) and antithrombin III (ATIII), were associated with multiple organ dysfunction. Around 68% of the patients who eventualy suffered MODS could have been identified beofre the first organ failure using a ATIII levels lower than 83.2% as a marker. Supplementation of PC and ATIII may discourage the progression of single organ dysfunction to MODS.

Diagnosis, Physiological aspects, Anticoagulants (Medicine), Anticoagulants, Multiple organ failure, Protein C, Antithrombin III

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