Virus infections in bone marrow transplant recipients: a three year prospective study

Article Abstract:

The use of bone marrow transplantation is increasing in the treatment of malignant and non-malignant diseases. Unfortunately, bone marrow transplantation is frequently complicated by graft versus host disease (GVHD) and infection, especially of viral etiology. Prophylaxis with the antiviral agent acyclovir has reduced the incidence of post-transplantation herpes virus infections. Other viruses, however, have affected transplant patients. Between October 1885 and September 1988, 81 bone marrow transplant recipients were studied. Thirty-two patients received allogenic transplants (bone marrow from a tissue-matched donor) and 49 had autologous transplants (of their own bone marrow). Diseases affecting the patients included various leukemias and lymphomas, neuroblastoma, myeloma, sarcoma, and aplastic anemia. All patients were treated with varying combinations of chemotherapy and whole body radiation. In addition, acyclovir was administered to the patients before and after bone marrow transplantation. Allogeneic transplant recipients received treatment with the immunosuppressive agent cyclosporin A as prophylaxis against GVHD. Symptomatic, allogeneic bone marrow transplant recipients were found to have infections caused by influenza A, cytomegalovirus, parainfluenza 2 and 3, herpes simplex virus, varicella-zoster virus, papovavirus and rhinovirus. In addition to these viruses (with the exception of cytomegalovirus), autologous transplant recipients developed adenovirus 1, 6, and F types, astrovirus, Coxsackie B3, and influenza B infections. The severity of illness varied among the patients. Thirty-five of the 81 patients died; 18 deaths were attributed to the recurrence of the underlying disease and 3 due to GVHD. In general, viral infections appeared to play minor roles in the morbidity and mortality of these patients. Diagnosis of viral infection on the basis of serological tests alone was found to be unreliable. Although virus presence in tissues was found at necropsy, in some instances, it was not serologically confirmed during life. Whenever possible, virus presence should be verified by the detection of viable virus, viral antigens or viral nucleic acid. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Risk factors, Virus diseases, Homografts, Autografts

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Early reconstitution of haematopoiesis after allogeneic bone marrow transplantation: a prospective histopathological study of bone marrow biopsy specimens

Article Abstract:

The histological changes that occur in the bone marrow of transplantation recipients have rarely been reported. Bone marrow transplants are used in cases of leukemia, lymphoma, and immunodeficiency diseases. The results describe 19 of the 24 pediatric bone marrow transplants conducted at the Leiden University Hospital (The Netherlands) between 1986 and 1988. Specifically, researchers evaluated the ability of the bone marrow to produce blood cells after allogenic transplantation (of bone marrow from a tissue-matched donor) by examining marrow biopsy specimens. In most cases, immunosuppressive agents, such as cyclosporine, were administered to prevent graft-versus-host-disease (GVHD). Biopsy specimens were taken during the third week after transplantation. Scoring of bone marrow reconstitution (new blood cell production) was recorded, and included details on cellularity, the ratio of erythroid versus myeloid cells, the stage of maturation of hematopoietic cells and other structural features. The results exhibited wide differences in both qualitative and quantitative aspects of hematopoiesis. Cellularity was variable, and localization of cell lineages and the ratios of myeloid cells to erythroid cells were abnormal. The absence of clustering of hematopoietic cells was associated with either failure of the graft or the relapse of leukemia. Post-transplantation infection and the administration of immunosuppressive drugs did not appear to influence the biopsy findings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Physiological aspects, Physiological regulation, Hematopoiesis, Childhood leukemia, Leukemia in children, Hematopoietic system

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Monitoring rejection after heart transplantation: cytoimmunochemical monitoring on blood cells and quantitative birefringence measurements on endomyocardial biopsy specimens

Article Abstract:

One of the first life-threatening complications following heart transplantation is acute rejection of the donated organ. Diagnosis of rejection is based on the histopathological evaluation of endomyocardial biopsy specimens (tissue examination of the membrane lining the heart and the heart muscle). Two methods of noninvasive testing were assessed to determine their value in diagnosing acute heart transplant rejection. They were also compared with histopathological examination of heart tissue. Noninvasive cytoimmunologic monitoring is based on inspection of mononuclear cells (lymphocytes and monocytes, white blood cells), combined with assessment of the phenotype (make-up) of lymphocyte populations. The number of activated lymphocytes permits the differentiation between graft acceptance, rejection and infection. Quantitative birefringence (which involves double refraction) measurements were performed on endomyocardial biopsy specimens to estimate the ability of myocytes (muscle cells) to contract. Extensive details concerning the techniques and interpretations of quantitative birefringence are offered. The authors conclude that cytoimmunological monitoring is useful for diagnosing acute rejection after heart transplantation. Birefringence measurements add little to the cytoimmunological measurements, except to provide background data on the damage caused to myocytes by the rejection process. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Heart, Graft rejection, Heart transplantation, Pathological histology, Cytodiagnosis, Refraction, Double, Double refraction

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