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  • 1
    Electronic Resource
    Electronic Resource
    Videofluoroscopy of the pharynx and esophagus in chronic graft-versus-host disease (1994)
    Springer
    Abdominal imaging 19 (1994), S. 191-194 
    Details
    ISSN: 1432-0509
    Keywords: Graft-versus-host-disease (GVHD) ; Bonemarrow transplantation, complications ; Esophagus, motility disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Successful allogeneic bone marrow transplantation (BMT) for hematologic disorders may be complicated by graft-versus-host-disease (GVHD). Chronic GVHD is a systemic disease, involving, among other organs, the skin, mouth, liver, and esophagus. Esophageal involvement results in mucosal inflammation, leading to submucosal fibrosis and, occasionally, formation of webs and strictures. We investigated 25 allogeneic BMT recipients (17 with and eight without chronic GVHD). All patients had a videofluoroscopic study of the pharynx and esophagus to determine the radiographic abnormalities characteristic of chronic GVHD. Oropharyngeal abnormalities (poor bolus control, pharyngeal retention, or excessive mucous secretions) were found in five patients with and three patients without GVHD. Only one patient with GVHD had a pharyngo-esophageal stricture. There was no significant difference between the two groups with regard to pharyngo-esophageal radiographic abnormalities and esophageal symptoms. Radiographic evidence of esophageal motility disorder is not specific for GVHD involvement. In the absence of specific radiographic features, endoscopy is the most accurate method for the diagnosis of esophageal involvement by GVHD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00203504
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  • 2
    Electronic Resource
    Electronic Resource
    Plasma exchange for treatment of thrombotic thrombocytopenic purpura in critically ill patients (1997)
    Springer
    Intensive care medicine 23 (1997), S. 44-50 
    Details
    ISSN: 1432-1238
    Keywords: Key words Thrombotic ; thrombocytopenic purpura ; Thrombotic microangiopathy ; Hemolytic uremic syndrome ; Intensive Care Unit ; Critical illness ; Plasma exchange
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Description of diagnostic procedures, treatment modalities and intensive care management of patients with thrombotic thrombocytopenic purpura (TTP). Design: Descriptive study. Setting: Internal medicine Intensive Care Unit (University Hospital of Vienna). Patients: Six patients (two after allogeneic bone marrow transplantation), treated for 12 episodes of TTP. Interventions: Treatment with plasma exchange (fresh frozen plasma, 50–80 ml/kg per day), prednisone (0.75 mg/kg b.i.d.) and, in some cases, vincristine. Supportive therapy as needed. Measurements and results: Patients were admitted to the ICU because of neurological symptoms with acute onset (42% mild, 58% severe), hemolysis and thrombocytopenia. Additional symptoms were fever (50%), bleeding tendency (50%), acute renal failure (42%) and metabolic derangement (8%). Initial laboratory values showed thrombocytopenia (median 17 G/l), hemolysis (median hemoglobin 10.0 g/dl, lactate dehydrogenase 635 U/l, reticulocyte count 175 G/l) with red cell fragmentation. Coagulation tests were normal. Respiratory assist was needed in six episodes (severe seizures, cardiopulmonary resuscitation). In patients without preexisting hematological abnormality the platelet counts exceeded 100 G/l after 3–8 cycles of plasma exchange. In patients after bone marrow transplantation, the platelet counts never exceeded 40 G/l, but the lactate dehydrogenase levels dropped significantly. The neurological symptoms disappeared in all patients and renal function normalized. One patient died before the initiation of therapy. Three patients relapsed 1–3 times between 2 weeks and 5 months after the last episode. The relapses were associated with symptoms similar to the first episode and responded promptly to plasma therapy. Conclusions: TTP is a rare, but life-threatening disorder. It needs immediate diagnosis and has a good prognosis after adequate treatment with plasma exchange.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050289
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  • 3
    Electronic Resource
    Electronic Resource
    Survival and quality of life in 23 patients with severe aplastic anemia treated with bone marrow transplantation (BMT) (1987)
    Springer
    Annals of hematology 54 (1987), S. 137-146 
    Details
    ISSN: 1432-0584
    Keywords: Severe aplastic anemia ; Bone marrow transplantation ; Graft versus host disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Survival and quality of life are reported in 23 pretransfused patients with severe aplastic anemia (SAA) who underwent bone marrow transplantation (BMT). The projected survival is 76% with 18 of 23 patients being alive 332 to 1677 days post graft (median: 842). 5 patients died between day 4 and 416. 12 of 17 patients at risk developed chronic graft versus host disease (GVH-D). 4 of these patients have a diminished quality of life due GVH-D related disabling manifestations. Autologous haemopoietic recovery was excluded in all patients by the demonstration of haemopoietic chimerism. We recommand age-adapted rejection prophylaxis; such strategy may help to diminish disabling graft versus host disease in otherwise haematologically reconstituted survivors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00320367
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  • 4
    Electronic Resource
    Electronic Resource
    FLAG (fludarabine, cytosine arabinoside, G-CSF) for refractory and relapsed acute myeloid leukemia (1996)
    Springer
    Annals of hematology 73 (1996), S. 265-271 
    Details
    ISSN: 1432-0584
    Keywords: Key words Acute myeloid leukemia ; FLAG ; Salvage therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Twenty-two patients with refractory or relapsed AML were treated with FLAG [25 mg/m2 fludarabine daily (days 1–5), 2 g/m2 daily Ara-C (days 1–5) and 400 μg/m2 daily G-CSF (day -1 till the absolute neutrophil count was 〉500/μl)]. Median age was 46 years (range 24–63). Eight patients had leukemia which was primarily refractory to conventional regimens, six were in first, seven were in second, and one was in third relapse. Overall, 11 of 22 (50%) patients achieved complete remission (CR), three had a partial response (PR), and seven did not respond (NR). One patient died of an early cerebral hemorrhage. The median remission duration from achievement of CR after FLAG was 9.9 months and median survival was 13.0 months. One patient is alive in CR at 31.9 months. Hematological toxicity of the regimen was severe. The median time to neutrophil recovery (ANC 〉500/μl) was 21 days (range 18–33). A median of seven red cell units (range 0–22) and of six platelet concentrate units (range 3–28) had to be given. Median duration of febrile neutropenia was 2 days (range 0–20 days) and patients were on i.v. antibiotics for a median of 16 days (range 0–51). There was no death from infection. Nonhematological toxicity was remarkably low, with almost no neurotoxicity and no major hepatotoxicity. In conclusion, FLAG seems to be an efficient and well tolerated regimen. It may be particularly useful for patients who have a sibling or unrelated donor for subsequent allogeneic bone marrow transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050239
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  • 5
    Electronic Resource
    Electronic Resource
    Symmetrical necrosis of globus pallidus with severe gait disturbance in a patient with myelodysplastic syndrome given allogeneic marrow transplantation (1997)
    Springer
    Annals of hematology 75 (1997), S. 235-237 
    Details
    ISSN: 1432-0584
    Keywords: Key words Globus pallidus necrosis ; Allogeneic marrow transplantation ; Myelodysplastic syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A 21-year-old Caucasian man received an allogeneic marrow transplant (BMT) from his HLA-identical brother because of myelodysplastic syndrome. He remained red blood cell (RBC) transfusion dependent with persistent antibodies against the donor's RBC. Six months following BMT the patient suddenly developed a severe akinetic syndrome with gait disturbance and frequent falls and bilateral symmetrical lesions in basal ganglia. Concomitantly, micrococcus species septicemia from an infected Hickman catheter developed. Despite antimicrobial therapy and withdrawal of cyclosporin A, neurologic abnormalities persisted and were unresponsive to various therapies. Ischemic damage due to a vascular event during severe infection could be the most probable reason for the lesions seen in our patient, although infectious or toxic complications cannot be ruled out.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050349
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  • 6
    Electronic Resource
    Electronic Resource
    Effect of high-dose melphalan and peripheral blood stem cell transplantation on renal function in patients with multiple myeloma and renal insufficiency: a case report and review of the literature (1999)
    Springer
    Annals of hematology 78 (1999), S. 189-191 
    Details
    ISSN: 1432-0584
    Keywords: Keywords Multiple myeloma ; Renal failure ; Peripheral blood stem cell transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Multiple myeloma with IgG-lambda monoclonal gammopathy and severe renal impairment with light-chain deposit disease was diagnosed in a 51-year-old man. Following conventional therapy with VAD (vincristine, adriamycin, dexamethasone) a partial remission was achieved. Peripheral blood stem cells (PBSC) were then collected following mobilization with cyclophosphamide and recombinant human granulocyte colony-stimulating factor and enriched for CD34-positive cells by immunoaffinity column. Fourteen months after diagnosis high-dose melphalan was given, followed by infusion of CD34-positive PBSC. Aside from mild oral mucositis and trigonitis, high-dose therapy was tolerated well. After he underwent PBSC transplantation his renal function improved, and the patient has been in in continuous complete remission for 1 year. Thus, high-dose chemotherapy can be safely administered to patients with multiple myeloma and severe renal impairment. Our findings confirm previous reports summarized in the current presentation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050499
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  • 7
    Electronic Resource
    Electronic Resource
    Effect of interleukin-3, stem cell factor and granulocyte–macrophage colony-stimulating factor on committed stem cells, long-term culture initiating cells and bone marrow stroma in a one-step long-term bone marrow culture (2000)
    Springer
    Annals of hematology 79 (2000), S. 243-248 
    Details
    ISSN: 1432-0584
    Keywords: Interleukin-3 ; Stem-cell factor ; Granulocyte ; macrophage colony-stimulating factor ; Bone marrow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050587
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  • 8
    Electronic Resource
    Electronic Resource
    Long-term follow-up of patients after related- and unrelated-donor bone marrow transplantation for chronic myelogenous leukemia (1999)
    Springer
    Annals of hematology 78 (1999), S. 507-513 
    Details
    ISSN: 1432-0584
    Keywords: Key words Related and unrelated donor BMT ; CML ; Long-term follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Between January 1983 and December 1997, 88 patients (36 female, 52 male, median age 37 years, range 19–57) with chronic myelogenous leukemia (CML) underwent allogeneic bone marrow transplantation (BMT) at the University Hospital of Vienna. Sixty patients were in chronic phase, 18 in accelerated phase, and ten in blast crisis. Marrow donors were HLA-identical siblings for 64 patients (BM 58, PBSC 6), 2-antigen-mismatched related donors (RD) for two, HLA-identical unrelated donors (URD) for 17, and 1-antigen-mismatched URD for five. The median time from diagnosis to BMT was 22 months (range 2–91), and 63 patients had received prior interferon (IFN)-alpha therapy, 46 (73%) for more than 6 months. Conditioning therapy consisted of cyclophosphamide (CY) and total body irradiation (TBI) in 71 patients and CY and busulfan (BU) in 16. One patient received etoposide and TBI. For graft-versus-host disease (GVHD) prophylaxis methotrexate (MTX) was given to 12 patients, MTX and cyclosporin A (CSA) to 67, CSA alone to four, and CSA and methylprednisolone to five. Durable engraftment was documented in 80 of 82 patients (98%). As of December 31, 1997, 52 patients (59%) were alive, 38 (58%) after sibling transplantation with a median observation time of 73 months and 14 (64%) after URD transplantation with a median observation time of 12 months. Probability of overall survival is 59%, for patients undergoing transplantation in chronic phase and 44% for patients undergoing transplantation in advanced stage CML. Probability of disease-free survival (DFS) after sibling and URD BMT is 55% and 59%, respectively. Ten patients (12%) experienced relapse of CML. Transplant-related mortality was 32% both after RD and after URD transplantation. Acute GVHD occurred in 53 of 80 evaluable patients (66%), consisting of grade III or IV in 14 patients (18%). Chronic GVHD developed in 40 of 63 eligible patients (63%), including extensive disease in 26 patients (41%). Thus, sibling and URD BMT offer high cure rates with acceptable toxicity to patients with CML.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050547
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  • 9
    Electronic Resource
    Electronic Resource
    Low curative potential of bone marrow transplantation for highly aggressive acute myelogenous leukemia with inversion inv (3)(q21q26) or homologous translocation t(3;3) (q21;q26) (2000)
    Springer
    Annals of hematology 79 (2000), S. 374-377 
    Details
    ISSN: 1432-0584
    Keywords: Key words Relapse ; AML ; BMT ; Chromosome 3
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Structural rearrangements of the long arm of chromosome 3 involving bands 3q21 and 3q26 and leading either to a paracentric inversion inv (3)(q21q26) or a translocation between both homologous chromosomes – t (3;3)(q21q26) – have been reported in patients with acute myelogenous leukemia (AML), myelodysplastic syndromes, myeloproliferative disorders, and chronic myelogenous leukemia in blast crisis. We describe three patients with de novo AML with these structural abnormalities who received multiple courses of conventional chemotherapy followed by unrelated donor (n=2) and autologous (n=1) bone marrow transplantation (BMT). All three patients had early relapse: patients 1 and 2 had relapse 69 days and 306 days after BMT, respectively, and patient 3 immediately after autologous BMT. Despite further chemotherapy, they died without achieving another remission. These findings, together with other recorded similar cases, show that AML with structural abnormalities of the long arm of chromosome 3 as described has an extremely poor prognosis even with the most potent anti-leukemic treatment modalities.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770000158
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  • 10
    Electronic Resource
    Electronic Resource
    Long-term leukemia-free survival after allogeneic marrow transplantation in patients with acute myelogenous leukemia (1996)
    Springer
    Annals of hematology 72 (1996), S. 53-59 
    Details
    ISSN: 1432-0584
    Keywords: Acute myelogenous leukemia ; Allogeneic marrow transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between February 1982 and April 1995, 62 patients (37 male, 25 female) with acute myelogenous leukemia (AML) with a median age of 32 years (19–51 years) received allogeneic marrow grafts from an HLA-identical sibling (n=60) or an HLA-mismatched family member (n=2). At the time of transplant, 35 patients were in first complete remission (CR), five in second CR, eight were primary refractory, eight were in untreated relapse and six in refractory relapse. The FAB subtypes were as follows: M1 (n=17), M2 (n=13), M3 (n=6), M4 (n=19), M5 (n=6), M6 (n=1). For conditioning most patients were given total body irradiation combined with cyclophosphamide (CY,n=50) or CY and busulfan (n=9). For graft-versus-host disease prophylaxis patients received cyclosporin A (CSA) and methotrexate (MTX) (n=32), MTX alone (n=12), CSA and methylprednisone (n=5), or CSA alone (n=13). As of April 1995, probability of leukemia-free survival projected at 10 years after BMT was 60% for patients transplanted in first CR compared with 10% for patients transplanted beyond first CR. Transplant-related mortality was 11% after BMT in first CR and 39% after BMT beyond first CR. Probability of relapse projected at 10 years after BMT is 32% for patients who received transplants in first CR and 81% for patients who received transplants beyond first CR. Thus, high-dose chemo/radiotherapy followed by allogeneic marrow infusion has a high curative potential for patients with AML who receive transplants in first CR and offers the chance of long-term disease-free survival for some patients with advanced disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00641308
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