scholarly journals Cytomegalovirus antigen detection in peripheral blood leukocytes after allogeneic marrow transplantation

Blood ◽  
1992 ◽  
Vol 80 (5) ◽  
pp. 1358-1364 ◽  
Author(s):  
M Boeckh ◽  
RA Bowden ◽  
JM Goodrich ◽  
M Pettinger ◽  
JD Meyers
Keyword(s):  
Marrow Transplantation ◽  
Gastrointestinal Disease ◽  
Marrow Transplant ◽  
Cmv Infection ◽  
Culture Methods ◽  
Blood Leukocytes ◽  
Shell Vial ◽  
Allogeneic Marrow Transplantation ◽  
Peripheral Leukocytes ◽  
Allogeneic Marrow

Abstract Detection of cytomegalovirus (CMV) antigenemia was compared with shell vial centrifugation cultures for rapid detection of CMV infection. In a prospective study, 59 CMV seropositive patients were monitored weekly during the first 100 days after allogeneic marrow transplantation for virus excretion from urine, throat, and blood and for antigenemia by direct staining of peripheral leukocytes using an antibody pool directed against pp 65. Antigenemia was present in 21 of 22 patients with culture-proven CMV infection and in 3 of 37 without culture-proven CMV infection (sensitivity 95%, specificity 91%). The median time of onset of antigenemia and shell vial cultures was day 47 and 55 after transplant, respectively (P = .0006). Among patients who developed CMV disease without preceding cultures, antigenemia was detected in all patients with CMV pneumonia (N = 6) and in two of three patients with gastrointestinal disease by a median of 10 and 7 days, respectively, before the onset of disease (P = .0002). Levels of antigenemia were significantly higher in patients with disease or viremia than in patients with excretion from urine or throat (P less than .05). Whether the antigenemia assay is more sensitive than rapid culture methods to focus antiviral prophylaxis in marrow transplant patients must be determined in controlled studies.

scholarly journals Cytomegalovirus antigen detection in peripheral blood leukocytes after allogeneic marrow transplantation

Blood ◽  
1992 ◽  
Vol 80 (5) ◽  
pp. 1358-1364 ◽  
Author(s):  
M Boeckh ◽  
RA Bowden ◽  
JM Goodrich ◽  
M Pettinger ◽  
JD Meyers
Keyword(s):  
Marrow Transplantation ◽  
Gastrointestinal Disease ◽  
Marrow Transplant ◽  
Cmv Infection ◽  
Culture Methods ◽  
Blood Leukocytes ◽  
Shell Vial ◽  
Allogeneic Marrow Transplantation ◽  
Peripheral Leukocytes ◽  
Allogeneic Marrow

Detection of cytomegalovirus (CMV) antigenemia was compared with shell vial centrifugation cultures for rapid detection of CMV infection. In a prospective study, 59 CMV seropositive patients were monitored weekly during the first 100 days after allogeneic marrow transplantation for virus excretion from urine, throat, and blood and for antigenemia by direct staining of peripheral leukocytes using an antibody pool directed against pp 65. Antigenemia was present in 21 of 22 patients with culture-proven CMV infection and in 3 of 37 without culture-proven CMV infection (sensitivity 95%, specificity 91%). The median time of onset of antigenemia and shell vial cultures was day 47 and 55 after transplant, respectively (P = .0006). Among patients who developed CMV disease without preceding cultures, antigenemia was detected in all patients with CMV pneumonia (N = 6) and in two of three patients with gastrointestinal disease by a median of 10 and 7 days, respectively, before the onset of disease (P = .0002). Levels of antigenemia were significantly higher in patients with disease or viremia than in patients with excretion from urine or throat (P less than .05). Whether the antigenemia assay is more sensitive than rapid culture methods to focus antiviral prophylaxis in marrow transplant patients must be determined in controlled studies.

scholarly journals Allogeneic marrow transplantation in patients positive for hepatitis B surface antigen

Blood ◽  
1991 ◽  
Vol 77 (1) ◽  
pp. 195-200 ◽  
Author(s):  
EC Reed ◽  
D Myerson ◽  
L Corey ◽  
JD Meyers
Keyword(s):  
Hepatitis B ◽  
Surface Antigen ◽  
Marrow Transplantation ◽  
Hepatitis B Surface Antigen ◽  
Marrow Transplant ◽  
Core Antigen ◽  
Immunoperoxidase Staining ◽  
Hbv Reactivation ◽  
Allogeneic Marrow Transplantation ◽  
Allogeneic Marrow

Twenty patients who were positive for hepatitis B surface antigen (HBsAg) underwent allogeneic marrow transplant for malignancy or other underlying hematologic disease between 1975 and 1986. After transplant, one patient had serologic evidence of hepatitis B virus (HBV) reactivation whereas three patients had evidence of an immune response to HBV. Among four patients with serologic follow-up of 1 year or more, three remained positive for HBsAg and one became HBsAg negative. Six patients (30%) developed clinical evidence of venocclusive disease and seven patients (35%) developed acute graft-versus-host disease involving the liver, but the incidence of these complications was similar to that expected among patients who are not carriers of HBsAg. Three patients died with hepatorenal failure, but all three had venocclusive disease and the contribution of HBV infection to liver failure was unclear. Available liver specimens obtained at autopsy (six patients) or biopsy (two patients) all showed either HBsAg (one specimen) or hepatitis B core antigen (four specimens) or both (three specimens) by immunoperoxidase staining. Although HBV reactivation leading to hepatic failure has been reported among allogeneic marrow transplant recipients as well as other immunocompromised patients, we did not observe an increase in the incidence of severe liver disease after transplant among these 20 patients positive for HBsAg at the time of transplant, and do not consider positivity for HBsAg to be a contraindication to allogeneic marrow transplantation.

Second allogeneic marrow transplantation for patients with recurrent leukemia after initial transplant with total-body irradiation-containing regimens.

1993 ◽  
Vol 11 (2) ◽  
pp. 304-313 ◽  
Author(s):  
J P Radich ◽  
J E Sanders ◽  
C D Buckner ◽  
P J Martin ◽  
F B Petersen ◽  
...  
Keyword(s):  
Total Body Irradiation ◽  
Marrow Transplantation ◽  
Acute Gvhd ◽  
High Dose Chemotherapy ◽  
Marrow Transplant ◽  
Myelogenous Leukemia ◽  
High Dose ◽  
Allogeneic Marrow Transplantation ◽  
Total Body ◽  
Allogeneic Marrow

PURPOSE The impact of a second marrow transplant on long-term disease-free survival (DFS) was evaluated for 77 consecutive patients aged 2 to 51 years who relapsed subsequent to allogeneic marrow transplantation after high-dose chemotherapy and total-body irradiation (TBI). PATIENTS AND METHODS Patients received a second transplant for recurrent chronic myelogenous leukemia (CML) (n = 28), acute myelogenous leukemia (AML) (n = 32), and acute lymphoblastic leukemia (ALL) (n = 15) or lymphoma (n = 2) that used the same marrow donor as the initial transplant. High-dose chemotherapy of busulfan (BU) and cyclophosphamide (CY), or CY, carmustine (BCNU), and etoposide (VP-16), was used as a preparative regimen for the second transplant. Graft-versus-host disease (GVHD) prophylaxis consisted of the following: no prophylaxis (n = 8), T-cell depletion (n = 36), methotrexate (MTX) only (n = 21), cyclosporine (CSP) only (n = 1), MTX and CSP (n = 9), or anti-thymocyte globulin (ATG) and prednisone (n = 2). RESULTS Engraftment occurred in the 74 assessable patients. Severe veno-occlusive disease (VOD) was the most frequent cause of grades 3 and 4 regimen-related toxicity (RRT); it occurred in 20 patients. The probability of death before day 100 from nonleukemic causes was 36%. The probability of relapse after second transplant was 70%, and the DFS rate was 14% (median DFS, 36 months; range, 22 to 87). The DFS rates for ALL, AML, and CML were 8%, 10%, and 25%, respectively. Multivariate analysis showed that the risk of relapse was inversely associated with acute GVHD (relative risk [RR] of relapse = 0.2; P = .0009). No other factor was associated with relapse. DFS was associated with the presence of acute GVHD (RR of treatment failure = 0.5; P = .0085), and a reduction of DFS was associated with severe VOD (RR = 10.6; P = .0001) and those patients older than 10 years (RR = 2.5; P = .0337). CONCLUSION These data show that some patients may benefit from a second marrow transplant for recurrent leukemia after an initial marrow transplant. Younger patients and patients with CML especially should be considered as potential candidates for a second transplant.

scholarly journals Allogeneic marrow transplantation in patients positive for hepatitis B surface antigen

Blood ◽  
1991 ◽  
Vol 77 (1) ◽  
pp. 195-200 ◽  
Author(s):  
EC Reed ◽  
D Myerson ◽  
L Corey ◽  
JD Meyers
Keyword(s):  
Hepatitis B ◽  
Surface Antigen ◽  
Marrow Transplantation ◽  
Hepatitis B Surface Antigen ◽  
Marrow Transplant ◽  
Core Antigen ◽  
Immunoperoxidase Staining ◽  
Hbv Reactivation ◽  
Allogeneic Marrow Transplantation ◽  
Allogeneic Marrow

Abstract Twenty patients who were positive for hepatitis B surface antigen (HBsAg) underwent allogeneic marrow transplant for malignancy or other underlying hematologic disease between 1975 and 1986. After transplant, one patient had serologic evidence of hepatitis B virus (HBV) reactivation whereas three patients had evidence of an immune response to HBV. Among four patients with serologic follow-up of 1 year or more, three remained positive for HBsAg and one became HBsAg negative. Six patients (30%) developed clinical evidence of venocclusive disease and seven patients (35%) developed acute graft-versus-host disease involving the liver, but the incidence of these complications was similar to that expected among patients who are not carriers of HBsAg. Three patients died with hepatorenal failure, but all three had venocclusive disease and the contribution of HBV infection to liver failure was unclear. Available liver specimens obtained at autopsy (six patients) or biopsy (two patients) all showed either HBsAg (one specimen) or hepatitis B core antigen (four specimens) or both (three specimens) by immunoperoxidase staining. Although HBV reactivation leading to hepatic failure has been reported among allogeneic marrow transplant recipients as well as other immunocompromised patients, we did not observe an increase in the incidence of severe liver disease after transplant among these 20 patients positive for HBsAg at the time of transplant, and do not consider positivity for HBsAg to be a contraindication to allogeneic marrow transplantation.

A CHRONIC PULMONARY SYNDROME ASSOCIATED WITH GRAFT-VERSUS-HOST DISEASE AFTER ALLOGENEIC MARROW TRANSPLANTATION

1992 ◽  
Vol 54 (6) ◽  
pp. 1002-1007 ◽  
Author(s):  
ANTHONY P. SCHWARER ◽  
J. MICHAEL B. HUGHES ◽  
BEATRICE TROTMAN-DICKENSON ◽  
THOMAS KRAUSZ ◽  
JOHN M. GOLDMAN
Keyword(s):  
Graft Versus Host Disease ◽  
Marrow Transplantation ◽  
Host Disease ◽  
Graft Versus Host ◽  
Allogeneic Marrow Transplantation ◽  
Allogeneic Marrow
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