RESUMEN
The authors describe the case of a 66-year-old female patient after transplantation of the kidney where a rare complication of immunosuppressive treatment was diagnosed--progressive multifocal leukoencephalopathy. The disease was manifested by gradually developing hemiparesis of the lower extremity five months after transplantation. Examination of the brain by computed tomography and examination of cerebrospinal fluid were normal. Subsequently the neurological finding developed into quadruparesis. Imaging of the brain by magnetic resonance revealed multiple demyelinization foci. In brain biopsy there were typical structures of progressive multifocal leukoencephalopathy and positive hybridization in situ for JC-virus in cell nuclei. Immunosuppressive treatment was restricted and ganciclovirus administration was started. Further progression of the clinical symptomatology ceased, the function of the transplanted kidney remained satisfactory. The patient died 14 months after the transplantation from sepsis. Examination of the post-mortem material revealed positivity of the JC-virus only in the cytoplasm of the affected cells. As effective treatment of infection with JC-virus is not known so far, the possible action of ganciclovirus is only speculative.
Asunto(s)
Terapia de Inmunosupresión/efectos adversos , Trasplante de Riñón , Leucoencefalopatía Multifocal Progresiva/etiología , Anciano , Femenino , HumanosRESUMEN
BACKGROUND: Bone marrow transplantation or transplantation of peripheral stem cells is an effective treatment of a number of diseases. Its increasing success and expanding use in associated with the development of molecular diagnostic methods which enable to follow up the graft from its engraftment in a recipient and then during the whole posttransplantation period at the level extremely small numbers of cells. METHODS AND RESULTS: In peripheral blood of patients, genotypes of the following loci were examined by polymerase chain reaction (PCR): APOB, COL2A1, D17S20, D1S80, HVR/1G, SRY and AMXY. Technique of restriction analysis was used for loci DXYS20 and DXYS75. 1. The first signs of donor bone marrow activity were observed in 50% of patients already at the beginning of the second week after transplantation, while in the second half of patients increasing number of donor cells in peripheral blood was noticed in the second and third week. 2. Engraftment with full and permanent substitution of own bone marrow without presence of recipients cells in peripheral blood--complete chimerism--was achieved only in a part of patients (cca 50%). 3. Peripheral blood of other patients did not contain only donor cells but also recipients cells--mixed chimerism. With regard to its onset, the authors have divided mixed chimerism into early and late, taking into account that some patients can develop both types. In patients under study, early chimerism was found more frequently, which apparently resulted from a shorter period of observation of lately transplanted patients. 4. In cases of oncohaematologic patients, which allowed to study specifically the presence of a pathologic clone, the follow-up of chimerism enabled to distinguish between relapse of the original disease and "biologic" recovery--resurrection of original disease-free haematopoiesis. 5. Regression of mixed chimerism was supposed to be the result of treatment focused at the original disease (CML), in some patients, however, it was a spontaneous process. CONCLUSIONS: Follow-up of cellular chimerism in transplanted patients by means of molecular genetic methods provides substantial information about patient's shape which can be utilized it is necessary to decide on treatment procedures. For this reason it is desirable that examination of chimerism by molecular methods should form integral part of care of these patients.
Asunto(s)
Células Sanguíneas , Trasplante de Médula Ósea , ADN/genética , Polimorfismo Genético , Quimera por Trasplante , Adolescente , Femenino , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Trasplante HomólogoRESUMEN
13 patients have been transplanted at Institute of Hematology and Blood Transfusion since 1995 using allogeneic PBPC either alone or with bone marrow as a source of progenitor cells. All donors were G-CSF mobilised HLA identical family members. PBPC harvests were performed on D 4,5, (6) of G-CSF administration. The medium content of TNC, CD34+, CD3+, CD4+and CD8+cells/kg b.w. of the recipients in the grafts were: 13,1x10(8)(TNC), 11,4x10(6)(CD34+), 393x10(6)(CD3+) 243x10(6)(CD4+), 125x10(6)(CD8+) The patients received either BuCy2 or CyTBI preparative regimen and Cyclosporin A + short course of Methotrexate for GVHD prophylaxis. Engraftment of ANC >500 was achieved by D+16 and PLT >20.000 by D+19. Three of ten evaluable patients developed acute and three of nine chronic GVHD. 8 patients survive with the longest follow up 776 days.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Adulto , Ciclosporina/uso terapéutico , República Checa , Femenino , Enfermedad Injerto contra Huésped/prevención & control , Movilización de Célula Madre Hematopoyética , Prueba de Histocompatibilidad , Humanos , Inmunosupresores/uso terapéutico , Recuento de Leucocitos , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad , Trasplante Homólogo , Resultado del TratamientoRESUMEN
The outcomes of bone marrow transplantation (BMT) performed at the Institute of Haematology and Blood Transfusion from April 1988 to December 1994 in 31 patients with chronic myelogenous leukemia are presented. Age of the patients range from 18 to 49 years, median 34 years. Male:female ratio was 1.58:1. The conditioning regimen consisted of Cyclophosphamide and total body irradiation (TBI) or Busulfan and Cyclophosphamide. The results are evaluated as of January 1, 1995. Nineteen patients (61.3%) are alive, 12 patients (38.7%) died. The causes of death are discussed. The median time of follow up all patients is 10.4 months, range 0.3-81.5. The median time of follow up of surviving patients is 21.8 months, range 2.5-81.5. Probability of 2 years survival by Kaplan-Meier analysis is 58 +/- 10%. Of the 24 transplanted in the first chronic phase, 18 patients are alive. Of the 7 transplanted in advanced phase of the disease, 1 patient is alive. Of the 27 patients, who received bone marrow from an HLA identical sibling, 19 are alive. Of the 4 patients who received bone marrow from other donor than an HLA identical sibling, none is alive. Acute GvHD III.-IV. grade developed in 5 patients (16.1%), moderate and severe chronic GvHD developed in 11 patients (31.5%). Cytogenetic relapse was diagnosed in 1 patient, hematological relapse in 2 patients. Karnofsky scores of patients surviving after BMT range from 30% to 100%, median 90%.
Asunto(s)
Trasplante de Médula Ósea , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Adolescente , Adulto , Trasplante de Médula Ósea/efectos adversos , Trasplante de Médula Ósea/mortalidad , Femenino , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/mortalidad , Masculino , Persona de Mediana Edad , Tasa de SupervivenciaRESUMEN
Leukemic blasts of two patients with acute leukemia exhibited similar characteristics. They were heterogeneous in size with a diameter of 14-30 microns in smears and unclassifiable by morphological, cytochemical, immunophenotypic and ultrastructural examinations. Cytogenetic examinations of both revealed a near-tetraploid karyotype. Blasts from both patients differentiated into macrophages in cultures with 10 ng/ml 12-O-tetradecanoylphorbol-13-acetate (TPA) which is a feature specific for myeloid blasts and the cases were thus classified as poorly differentiated acute myeloid leukemias (AML M0). Near-tetraploid poorly differentiated acute myeloid leukemias M0 seem to be a special category of AML in the morphologic, immunologic and cytogenetic (MIC) classification. The presence of very large blasts in the heterogeneous blast population in acute unclassified leukemias could be a morphological sign of near-tetraploid leukemias AML M0.
Asunto(s)
Leucemia Mieloide Aguda/patología , Anciano , Diferenciación Celular/efectos de los fármacos , ADN de Neoplasias/análisis , Femenino , Humanos , Inmunofenotipificación , Leucemia Mieloide Aguda/diagnóstico , Masculino , Persona de Mediana Edad , Poliploidía , Acetato de Tetradecanoilforbol/farmacologíaRESUMEN
BACKGROUND: After bone marrow transplantation serious complications develop which may limit the success of this therapeutic method. One of the early complications is an acute graft versus host reaction. The objective of the investigation was to evaluate the relationship between the number of active lymphocytes in the patient's blood stream after bone marrow transplantation and the development of an acute graft versus host reaction or rejection of the graft, and thus contribute towards prediction or diagnosis of these complications. METHODS AND RESULTS: In 14 patients with acute myeloid leukaemia (3), acute lymphatic leukaemia (1), chronic myeloid leukaemia (6), myelodysplastic syndrome (2) and aplastic anaemia (2) bone marrow was transplanted: the donor was in all instances a HLA identical sibling. However, only 11 patients were evaluated. In the latter changes in the number of circulating active lymphocytes were assessed: their activity was evaluated from nucleolar characteristics expressed by RNA synthesis. Their values at the time of the acute graft versus host reaction (GVHD) varied between 7.4% and 17.3%; at the time when these patients were free from complications they were 2.2%-6.0% (the difference is at the borderline of significance). In 8 patients the rise of active lymphocytes preceded the manifestation of the graft versus host reaction by 3-7 days. At the time of infectious complications after bone marrow transplantation (temperatures of obscure origin, herpetic infections, varicella, adenoviral infections) the number of active lymphocytes did not increase (2.0%-10.0%), as compared with 3.4%-9.5% in the group without complications. CONCLUSIONS: The increased percentage of activated lymphocytes in the peripheral blood stream of patients with an acute graft versus host reaction (GVHD) after bone marrow transplantation results from specific immunological procedures. Their assessment could help with the differential diagnostic difficulties frequently associated with the diagnosis of the acute graft versus host reaction.
Asunto(s)
Trasplante de Médula Ósea , Activación de Linfocitos , Rechazo de Injerto/diagnóstico , Enfermedad Injerto contra Huésped/diagnóstico , HumanosRESUMEN
The follow-up of patients after bone marrow transplantation (BMT) revealed some discrepancies between red blood cell and white blood cell origin. In all six patients under study, the DNA analysis showed full engraftment, while red blood cells in some of them indicated persistence of recipient bone marrow activity. Abnormalities detected by the probe p362A (XY homologous region) in electrophoretic patterns observed during the period of graft versus host disease (GVHD) are discussed.
Asunto(s)
Trasplante de Médula Ósea , Quimera/genética , ADN/análisis , Eritrocitos/citología , Estudios de Seguimiento , Humanos , Reacción en Cadena de la Polimerasa , Polimorfismo GenéticoRESUMEN
The first allogenic bone marrow transplantation (TKD), when for the preparation whole body irradiation was used, was implemented in the Institute of Haematology and Blood Transfusion (UHKT) in Prague in 1986. Before June 1992 36 TKD were performed incl. 28 allogenic, 2 syngenic and 6 autologous. For the first time bone marrow from a non-related donor was transplanted. Of 30 allogenic and syngenic TKD to the present time 17 patients survive, i.e. 56.6% of the whole group. According to individual diagnoses 8 patients with the diagnosis of chronic myeloid leukaemia (CML) survive, 5 of 10 patients with the diagnosis of acute leukaemia (AL) and 3 of 4 patients with the diagnosis of severe aplastic anaemia (SAA) or with Fancon's anaemia (FA) resp. The survival period of the whole group is from 1-62 months since the transplantation. The main cause of death of 8 from 13 patients who died were infections associated with acute or chronic disease of the graft against the host (GVHD). In autologous TKD the bone marrow was treated with etoposide. Of the six transplanted patients with AL five survive 1.5-30 months after transplantation. The authors present some general information of pretransplantation preparation, prevention of GVHD, its incidence and results of TKD.
Asunto(s)
Trasplante de Médula Ósea , Adolescente , Adulto , Humanos , Persona de Mediana EdadRESUMEN
The authors describe a positive crossover reaction between serum of a female patient treated with rabbit antithymocytic globulin and donor lymphocytes. In the serum of the patient with inhibition of the bone marrow HLA cytotoxins, thrombolysins, granulocytotoxins and granuloagglutinins were detected. Complete and incomplete thromboagglutinins were not detected. Two days after the positive tests no type of antibodies was detected in the patient's serum. The authors discuss the reasons for the development of the crossover reaction.