Serial Assessment of Cardiac Function and Morhology Using Transthoracic Echocardiography after Bone Marrow Transplatiation

PURPOSE: Bone Marrow Transplantation (BMT) is very stressful treatment to the patients' hearts. The aim of this study was to evaluate the serial change of cardiac function and morphology on echocardiography and to propose the guidelines of echocardiographic monitoring in BMT patients. METHOD: We divided the 64 patients (M:F=42:22, mean age 33+/-9, 25 AML, 8 ALL, 19 CML, 12 others) with hematologic diseases into early group (M:F=22:7, mean age=33+/-9) whose follow up echocardiograms were taken within 90 days, and late group (M:F=20:15, mean age=33+/-8) whose follow up echocardiograms were taken beyond 90 days after BMT. In both groups, changes of left ventricular dimensions, ejection fraction, wall thickness, E/A ratio and deceleration time (DT) were measured before and after BMT. RESULTS: Cardiac complications were observed in 18 pateints after BMT. The pericardial effusion in 6, benign arrhythmias in 6, including sinus arrhythmia, premature ventricular contraction, premature atrial contraction developed in the early group, but 5 of 6 patients who had ejection fraction less than 40% were in the late group. After BMT, the thickness of interventricular septum and left ventricular posterior wall was significantly increased (p<0.05) and ejection fraction and E/A ratio was significantly decreased (p<0.05, respectively) in the early group. In the late group the thickness of interventricular septum returned to normal range, but ejection fraction was significantly decreased (p<0.05) and deceleration time significantly (p<0.05) shortened. CONCLUSION: This study shows that the early cardiac change after BMT is mainly decrease of LV systolic function with hypertrophy and the late change is not only decrease of systolic function but also change of diastolic parameters. Therefore the serial assessment of cardiac function and morphology using transthoracic echocardiography is essential for the early diagnosis of cardiac toxicity, especially early after BMT.

A Case of Eosinophilic Folliculitis after Allogenic Bone Marrow Transplantatino in Acute Myelogenous Leukemia

Eosinophilic folliculitis (EF) is regarded as a variant of eosinophilic pustular folliculitis (EPF), because it has a few distinctive clinical features different from those of EPF. EF is generally associated with systemic disorders, such as acquired immunodeficiency syndrome (AIDS) and hematologic malignancies. We have recently experienced a case of EF occurring in a 40 year-old male patient treated with allogenic bone marrow transplantation (BMT) for acute myelogenous leukemia(AML) and achieved a good clinical outcome after a short course of systemic corticosteroid therapy. The immunologic aberration resulting from systemic diseases may play a role in the development of EF.

THE STRATEGIES FOR PREVENTING AND TREATING INFECTION OF CYTOMEGALOVIRUS IN BONE MARROW TRANSPLANTATION / 药物分析学报

In bone marrow transplantation (BMT), cytomegalovirus (CMV) interstitial pneumonitis (IP) is one of the most dangerous complications, which has been the first important cause to lead the failure of BMT. At present, there is no effective and specific therapy for CMV-IP, therefore how to prevent CMV infection effectively is a top task. From 1991 to 1996, we used comprehensive steps to prevent CMV-IP in BMT, and none of 14 patients developed CMV-IP. The preventing results that we achieved by using the steps were quite satisfied.

High-Efficiency Retroviral Vector Containing Human Mutated Dihydrofolate Reductase cDNA and Its Expression in Murine Hematopoietic Progenitor Cells / 中国肿瘤生物治疗杂志

A double-copy Moloney leukemia virus-based retroviral vector containing both the Neo~(R) gene and a mutant human dihydrofolate re-ductase(S31 mutation) cDNA was packaged into the Amphotropic packaging cell hne GP-EAM12( AM12), and a Amphotropic producer cell hne (named AM12-S31)was obtained. In this study, we investigated its drug resistant characteristics, viral titer and for murine hematopoietic progenitor cells transduction as well. MTT assay verified that the AM12-S31 cells were resistant to G418 and methotrexate(MTX), the IC50 were more than 800 ?g/ml and 100 ?M respectively while the control cell line AM12 was sensitive to both drugs, the IC50 were 180 ?g/ml and 10 ?M, respectively. The viral titer for this cell line was approximately 7.8? 104~4.2? 105 G418-resistant colony forming units/ml. The replication-competent virus can not be detected in this producer cell line. We also use the AM12-S31 cells to transfect murine hematopoietic cells (By coculture) . The positive colonies were found in all the G418 concentrations using CFU-GM assay. No G418-resistant colony was found using AM12 transfection. The infected murine marrow cells were returned to lethally irradiated(900rad)recipients. The murine transplanted with AM12-S31 infected marrow cells showed protection from lethal MTX toxicity as compared with AM12 infected animals. Evidence for integration and the proviral DNA was obtained by PCR amplification of proviral DNA. These results indicated this producer cell hne could produce high titer, high-efficiency and non-replcational competent virus. The murine marrow cells could be transfected successfully using this system, and express the foreign gene. The lethal irradiated murine marrow function could be reinstitution by infusing the hematopoietic progenitor cells tranducted with human mutant dihydrofolate reductase. In my opinion, this system would play an important role in research the long-term protection of murine marrow hematopoietic function and drug resistant gene therapy.