Successful allogeneic transplantation of T cell-depleted bone marrow from closely HLA-matched unrelated donors

Article Abstract:

The transplantation of bone marrow has become the treatment of choice for some diseases, especially leukemia and other blood cell cancers. Bone marrow transplantation (BMT) is also used to treat some congenital deficiency diseases, as well as disorders of marrow failure, either natural or induced. Unfortunately, in the majority of cases it is not possible to find a donor who is HLA-compatible (human leukocyte antigen-compatible). Any transplanted graft which is not HLA-matched may result in graft rejection or graft-versus-host disease (GVHD), in which immunologically competent cells within the grafted tissue attack cells of their new host. As a result, the long-term survival rates of patients with unmatched transplantations are worse than those with HLA-matched donors. New techniques, however, are improving the chances of patients for whom an HLA-matched donor is not available. BMT recipients with cancer underwent chemotherapy and radiotherapy prior to transplantation; patients with aplastic anemia, or other non-cancerous disorders requiring BMT, received a modified chemotherapy or radiotherapy appropriate for their condition. These treatments destroy many of the host's immune cells which could potentially recognize and attack the foreign cells of the marrow graft. The bone marrow to be grafted is treated with monoclonal antibodies to a T cell antigen called CD3. In the presence of complement protein, the T cells recognized by the antibody are punctured and destroyed. The collection of bone marrow cells has now been depleted of many of the cells which might mount a graft-versus-host response. After transplantation, patients are isolated in rooms with filtered air and administered antibiotics to help them through the period of re-organization of their immune system. Of the 55 BMT recipients treated in this manner, 31 died. The major cause of death was infection; in 11 cases infection was acquired after surgery. In four cases of aspergillosis, the infection was believed to be a recurrence of a pre-existing infection. Two patients died of graft failure; three patients died of GVHD. Although these survival rates are not as good as those seen with HLA-matched donors, they represent an improvement over those seen with partially-matched donors without T cell depletion. Bone marrow transplantation from unrelated donors appears to be a potentially useful treatment for those cases in which matched donors are unavailable, and consideration of this treatment in relation to other available procedures must be made. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Prevention, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Graft versus host reaction, Graft vs. host disease

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Late renal dysfunction in adult survivors of bone marrow transplantation

Article Abstract:

Bone marrow transplantation is becoming more common as a part of cancer treatment, particularly for cancers involving blood cells, such as lymphomas and leukemias. New techniques are constantly evolving which increase the chances of success while at the same time reducing the likelihood of adverse effects of this procedure. However, it is now recognized that a fraction of the patients who have received bone marrow transplantation will develop kidney problems. Unfortunately, it is difficult to determine precisely what causes this kidney damage. In general, cancer patients have been subjected to numerous different treatments, and it is difficult to ascertain which may have contributed the most to the kidney disorder. For example, bone marrow transplant recipients may be affected by the intensive chemotherapy they usually receive before transplantation, by drugs administered to suppress the immune response, by graft-versus-host disease in which the transplanted bone marrow attacks the organs of its new host, and by radiotherapy. In order to determine which of these factors contributes most strongly to the likelihood of kidney disease, a study was undertaken of 103 bone marrow transplant recipients. A total of 14 of these patients developed kidney disease; the complications have led to the death of two patients. Considering the time intervals over which these complications developed, it may be anticipated that 20 percent of patients will experience kidney disease within one year of bone marrow transplantation. While it was difficult to completely rule out any of the possible contributing factors, the most likely culprit in causing the kidney disease seems to be whole-body irradiation. Every patient with kidney disease had received at least 14 Gy of total body irradiation. (A Gy, or Gray, is a dose of radiation equivalent to one joule of energy absorbed per kilogram of tissue. It is equal to 100 rads.) In the present series of patients, 14 had received less than 14 Gy of total body irradiation; none of these patients developed kidney disease. It must be carefully determined if it is possible to shield the kidneys from radiation without impairing the success of the bone marrow transplantation or affecting the relapse rates of the cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Chronic kidney failure

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Autologous bone marrow transplantation versus intensive consolidation chemotherapy for acute myeloid leukemia in childhood

Article Abstract:

Autologous bone marrow transplantation seems to be no more effective in treating children with acute myeloid leukemia (AML) than chemotherapy. Autologous bone marrow is taken from the patient before treatment and given back during treatment. Of 232 children in remission from AML, 117 were treated with chemotherapy and 115 with autologous bone marrow transplants. Fifteen percent of the children who received an autologous bone marrow transplant died from the treatment, compared to 3% who died from chemotherapy. After three years, the overall and event-free survival rates were similar in the two groups. Survival rates in children who received bone marrow from a donor were higher than in those who received their own bone marrow. Most of the children with Down syndrome received chemotherapy and their 3-year survival rate was substantially higher than most of the other children.

Care and treatment, Evaluation, Chemotherapy, Acute leukemia, Promyelocytic, Acute myelocytic leukemia

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