Asunto(s)
Bancos de Sangre/normas , Tipificación y Pruebas Cruzadas Sanguíneas/métodos , Programas Informáticos , Sistema del Grupo Sanguíneo ABO/sangre , Bancos de Sangre/estadística & datos numéricos , Incompatibilidad de Grupos Sanguíneos/prevención & control , Tipificación y Pruebas Cruzadas Sanguíneas/estadística & datos numéricos , Europa (Continente) , Humanos , Isoanticuerpos/sangre , Japón , Garantía de la Calidad de Atención de Salud , Encuestas y Cuestionarios , Estados Unidos , United States Food and Drug AdministrationRESUMEN
A non-myeloablative conditioning protocol containing dibromomannitol (DBM/cytosine arabinoside/cyclophosphamide) has been applied to 36 chronic myeloid leukemia (CML) patients followed by bone marrow transplantation (BMT) from sibling donors. Risk factors include: accelerated phase (10 patients), older age (17 patients over >40 years) and long interval between diagnosis and BMT (27 months on average). Severe mucositis did not occur. Venoocclusive liver disease was absent. Infectious complications were rare. Although grade II-IV acute graft-versus-host disease (GVHD) was present in 9 (25%) cases, there were only 2 serious (III-IV) ones. Chronic GVHD occurred in 25 (69%) cases, preceded by acute GVHD in 9 of the 25 affected patients. Early hematological relapse, 7-29 weeks after BMT, developed in 6 patients (17.6%). No relapse was noted in the completely chimeric patients, however molecular genetic residual disease was observed in 6 patients, in most of them after transient short-term mixed chimeric state. Overall actual survival rate is 83.3% for the 36 cases, and leukemia-free survival is 72.2% for the 34 engrafted patients.
Asunto(s)
Trasplante de Médula Ósea/métodos , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Mitobronitol/administración & dosificación , Acondicionamiento Pretrasplante/métodos , Adolescente , Adulto , Anciano , Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/normas , Antineoplásicos Alquilantes/toxicidad , Trasplante de Médula Ósea/normas , Causas de Muerte , Supervivencia sin Enfermedad , Femenino , Enfermedad Injerto contra Huésped , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Masculino , Persona de Mediana Edad , Mitobronitol/normas , Mitobronitol/toxicidad , Tasa de Supervivencia , Quimera por Trasplante , Acondicionamiento Pretrasplante/normas , Trasplante Homólogo/métodosAsunto(s)
Sistema del Grupo Sanguíneo ABO/inmunología , Linfocitos B/inmunología , Incompatibilidad de Grupos Sanguíneos , Supervivencia de Injerto/fisiología , Hemólisis , Trasplante de Riñón/inmunología , Quimera por Trasplante , Femenino , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/fisiología , Masculino , Estudios Retrospectivos , Síndrome , Donantes de TejidosRESUMEN
Chimerism is an exceptional immunogenetic state, characterized by the survival and collaboration of cell populations originated from two different individuals. The prerequisites to induce chimerism are immunosuppression, myeloablation or severe immunodeficiency of the recipients on one side and donor originated immuno-hematopoietic cells in the graft on the other. Special immunogenetic conditions to establish chimerism are combined with bone marrow transplantation, transfusion and various kinds of solid organ grafting. There are various methods to detect the type of chimera state depending on the immunogenetic differences between the donor and recipient. The chimera state seems to be one of the leading factors to influence the course of the post-transplant period, the frequency and severity of graft-versus-host disease (GVHD), and the rate of relapse. However, the most important contribution of the chimeric state is the development of graft versus leukemia (GVL) effect. A new conditioning protocol (DBM/Ara-C/Cy) for allogeneic BMT in CML patients and its consequence on chimera state and GVL effect is demonstrated.
RESUMEN
Chimerism is an exceptional immunogenetic state, characterized by the survival and collaboration of cell populations originated from two different individuals. The prerequisits to induce chimerism are immuno-suppression, myeloablation, or severe immunodeficiency of the recipients on the one side and donor originated immuno-hematopoietic cells in the graft on the other. The pathologic or special immunogenetic conditions to establish chimerism are combined with bone marrow transplantation, transfusion, and various kinds of solid organ grafting. Different types of chimerism are known including complete, mixed and mosaic, or split chimerism. There are various methods used to detect the type of chimera state, depending on the immunogenetic differences between the donor and recipient. The induction of complete or mixed chimerism is first determinated by the effect of myeloablative therapy. The chimera state seems to be one of the leading factors to influence the course of the post-transplant period, the frequency and severity of GVHD, and the rate of relapse. However, the most important contribution of the chimeric state is in development of graft versus leukemia effect. A new conditioning protocol (DBM/Ara-C/Cy) for allogeneic BMT in CML patients and its consequence on chimera state and GVL effect is demonstrated.
Asunto(s)
Trasplante de Médula Ósea/inmunología , Quimera por Trasplante/inmunología , Antineoplásicos Alquilantes/farmacología , Ciclofosfamida/farmacología , Citarabina/farmacología , Enfermedad Injerto contra Huésped/inmunología , Humanos , Inmunosupresores/farmacología , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Mitobronitol/farmacología , Quimera por Trasplante/efectos de los fármacos , Resultado del TratamientoAsunto(s)
Rechazo de Injerto/prevención & control , Enfermedad Injerto contra Huésped/inmunología , Trasplante de Riñón/inmunología , Transfusión de Plaquetas , Adulto , Anemia Hemolítica/etiología , Anemia Hemolítica/inmunología , Linfocitos B/inmunología , Proteínas del Sistema Complemento/inmunología , Padre , Rechazo de Injerto/inmunología , Prueba de Histocompatibilidad , Humanos , Inmunoglobulina G/inmunología , Terapia de Inmunosupresión/métodos , Inmunosupresores/uso terapéutico , Donadores Vivos , Prueba de Cultivo Mixto de Linfocitos , Masculino , Hemisuccinato de Metilprednisolona/uso terapéutico , Persona de Mediana EdadRESUMEN
A new, radiation-free, conditioning protocol, containing the original Hungarian mitobronitol (DBM) (DBM/ cytosine arabinoside/cyclosphosphamide) has been applied to 36 chronic myeloid leukemia (CML) patients followed by bone marrow transplantation (BMT) from HLA identical sibling donors between 1990-1997. In spite of some prognostically disadvantageous factors (half of them were above 40 years, 10 out of 36 patients were in accelerated phase, the disease history was longer than 2 years in average) the overall survival (30/36) and the leukemia free survival rate (26/36) were in accordance with the best international results. Transplantation-related toxicity was remarkably reduced in comparison to bone marrow transplantation performed by total body irradiation/cyclophosphamide (TBI/Cy) or busulphan/cyclophosphamide (Bu/Cy) conditioning protocols. Acute graft versus host disease was present in lower percentage (9/36) and the number of serious cases was only 2/36. Chronic GVH disease, generally known to be associated with antileukemic effect (GVL), occurred in 25 of cases. Early haematological relapse among the 34 patients with functioning graft occurred in 6 patients which rate is slightly higher than reported after TBI/Cy or Bu/Cy conditioning treatment. There was no relapse among patients transplanted within one year post-diagnosis and patients having CML with accelerated phase. The leukemia free post-transplant period was in association with the chronic GVH disease and full chimeric state.
Asunto(s)
Trasplante de Médula Ósea , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Mitobronitol/uso terapéutico , Adolescente , Adulto , Protocolos Clínicos , Femenino , Reacción Injerto-Huésped/efectos de los fármacos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Requirement of blood supplementation is especially high in liver transplantation. Authors demonstrate the quantity and quality of blood and blood preparates used in the Transplantation and Surgical Department in Budapest during liver transplantation. Praxis of transfusion and the mode in the sustain of coagulation are shown. Dates in Hungary are compared to those in abroad. They conclude that these dates are comparable to each others.
Asunto(s)
Transfusión Sanguínea , Trasplante de Hígado , Bancos de Sangre , Donantes de Sangre , Incompatibilidad de Grupos Sanguíneos , Conservación de la Sangre , Humanos , HungríaRESUMEN
The authors report the strategy of invasive management of Rh alloimmunisation in pregnancy. From the 34 pregnancies 6 were monitored by amniocenteses, 11 by fetal blood sampling, and 4 with combination of the two above mentioned diagnostic procedures. In 13 cases the fetuses were treated with intrauterine intravascular blood transfusions. All the procedures were ultrasound guided. The fetal blood sampling and the transfusions were carried out by puncturing the umbilical vein or artery. For transfusions, maternal blood was used in case of identical blood type, otherwise adult Rh negative, filtered, washed, irradiated blood was transfused. They report the complications as well, giving the cause of their fetal losses in details. There were no maternal complications observed. Out of the 34 pregnant women 25 had healthy newborns, which number is acceptable in this disease with a very high mortality rate. The authors underline that the technique of fetal blood sampling and intrauterine transfusion if needed is necessary in the management of Rh alloimmunised pregnancies.
Asunto(s)
Transfusión de Sangre Intrauterina , Complicaciones del Embarazo/inmunología , Isoinmunización Rh/terapia , Adulto , Amniocentesis , Femenino , Sangre Fetal/inmunología , Humanos , Embarazo , Isoinmunización Rh/inmunologíaRESUMEN
The purpose of this study was to establish the frequency of the occurrence of in vitro haemolytic antibodies in donors, pregnant women and patients. The relatively high incidence of the Lewis blood group antibodies both in the group of pregnant women and patients is underlined.
Asunto(s)
Anticuerpos/inmunología , Eritrocitos/inmunología , Proteínas Hemolisinas/inmunología , Femenino , Humanos , Antígenos del Grupo Sanguíneo de Lewis/inmunología , Tamizaje Masivo , Embarazo , Estaciones del AñoRESUMEN
A rare case of toxic shock syndrome developing after an elective septoplasty and partial turbinectomy is reported. The sterile vaseline gauze packing acting as a "nasal tampon" is postulated as the mechanism of insult. The symptomatology, investigation and management of this case are discussed. Early recognition and appropriate treatment may avert the significant morbidity associated with this condition.