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Biomedical subjects

J Mehta

Publications and source records attributed to J Mehta.

At least 181 records · Page 10Linked to original sources
PubMed1994

Guillain-Barré syndrome after bone marrow transplantation.

A patient with chronic myeloid leukemia developed Guillain-Barré syndrome 4 months after allogeneic bone marrow transplantation. Clinical improvement occurred after a series of plasma exchanges. A relapse of the Guillain-Barré syndrome was also successfully treated with plasma exchange, with an eventual near-complete recovery. Reactivation of cytomegalovirus infection as manifested by antigenemia 2 months prior to the weakness was probably the precipitating event in this patient. We advocate early treatment of post-transplant Guillain-Barré syndrome with plasma exchange.

Adult↗
PubMed1994

Bone marrow transplantation for primary refractory acute leukaemia.

Twenty-four patients with primary resistant acute leukaemia received bone marrow transplants (BMTs) from matched sibling, syngeneic, matched unrelated, or mismatched family donors as treatment for induction failure. Three (12.5%) patients are alive and well 2-10 years after transplantation. Four (16.7%) patients died of transplant-related complications early post-transplant and remission status could not be determined. Two patients did not achieve complete remission (CR) and died of cytomegalovirus pneumonitis 3 months post-transplant. One patient died of graft failure. CR was obtained in 17 of 20 (85%) evaluable patients after BMT. Ten of 17 (58.8%) patients achieving CR died of transplant-related complications 1-10 months post-transplant. Four of 17 (23.5%) patients who had achieved CR relapsed after transplant. We conclude that a high proportion of patients failing to achieve remission with aggressive conventional chemotherapy achieve CR with BMT and a small proportion become long-term survivors.

Adolescent↗
PubMed1994

Total lymphoid irradiation, anti-lymphocyte globulin and Campath 1-G for immunosuppression prior to bone marrow transplantation for aplastic anemia after repeated graft rejection.

Allogeneic BMT for severe aplastic anemia is associated with a significant rate of graft rejection, especially in patients who have been previously transfused. We report a child with aplastic anemia who rejected donor marrow twice despite adequate immunosuppression as part of the conditioning therapy but engrafted successfully following combined administration of three modalities of immunosuppression: antithymocyte globulin, total lymphoid irradiation and the monoclonal antibody Campath-1G. Restriction fragment length polymorphism studies > 1 year after BMT show full donor hematopoiesis with no evidence of autologous recovery.

Alemtuzumab↗
PubMed1994

Graft failure after bone marrow transplantation from unrelated donors using busulphan and cyclophosphamide for conditioning.

Five patients received bone marrow allografts for leukaemia from serologically fully matched unrelated donors. The conditioning regimen was busulphan 16 mg/kg and cyclophosphamide (CY) 120 mg/kg. Engraftment was achieved in only two patients, with primary graft failure occurring in three patients. Two of the three patients with no evidence of myeloid engraftment on day 28 received GM-CSF without response. Both these patients required rescue with cryopreserved autologous material. Three patients remain alive, one died of relapse after a successful allograft and one died with pancytopenia. Although the number of patients is small, we conclude that the BuCY2 regimen with 120 mg/kg CY, while adequate for sibling allografts, may not be sufficiently immunosuppressive to permit consistent engraftment of bone marrow from unrelated donors.

Adult↗
PubMed1994

Systemic fungal infections: major problems in cancer patients.

Over the last decade, with increasing use of aggressive chemotherapy and bone marrow transplantation in the treatment of cancer, fungi have emerged as a major pathogen. The prognosis of established systemic fungal infections remains poor, but newer antifungal drugs such as fluconazole are changing the outlook of therapy and prophylaxis considerably.

Antifungal Agents↗
PubMed1993

Phenoxyethanol is effective topical therapy of gram-negative cellulitis in neutropenic patients.

In neutropenic patients cellulitis caused by Gram-negative organisms may prove difficult to control and cause considerable tissue damage. Phenoxyethanol has activity against a range of bacteria, including Pseudomonas aeruginosa, and is absorbed by intact skin. Three severely neutropenic patients are described in whom cellulitis failed to respond to appropriate intravenous antibiotics. However the topical application of phenoxyethanol solution gave prompt local control. This cheap and nontoxic agent may give dramatic improvement in this difficult clinical situation.

Administration, Topical↗
PubMed1993

Transplantation of autologous peripheral blood stem cells mobilized using GM-CSF for acute leukemia with myelofibrosis.

A patient with acute mixed lineage leukemia had marked marrow fibrosis at presentation. The fibrosis persisted despite achievement of complete remission. Because the marrow was inaspirable, granulocyte-monocyte colony-stimulating factor (GM-CSF) was used to mobilize stem cells into the peripheral blood which were used for autologous transplantation. Myeloid engraftment was rapid. The extent of the fibrosis decreased after transplantation. GM-CSF-mobilized peripheral blood stem cells may be used for autologous transplantation in patients with fibrotic marrows who are not candidates for allografting.

Acute Disease↗
PubMed1993

Graft-versus-leukemia reactions in clinical bone marrow transplantation.

Immunologic reactions occurring after allogeneic bone marrow transplantation, known as graft-versus-leukemia effect, contribute significantly to the control of minimal residual disease and decreased risk of relapse post-transplant. Graft-versus-leukemia reactions occur with or without graft-versus-host disease and are either mediated through T-cells or are independent of T-cells. The contribution made by graft-versus-leukemia reactions to improvement in overall survival depends upon the underlying type of leukemia, the nature of the marrow graft and the morbidity of any associated graft-versus-host disease. This article reviews the evidence demonstrating graft-versus-leukemia effect in clinical bone marrow transplantation, some approaches to dissociate graft-versus-leukemia from graft-versus-host disease, and attempts to induce graft-versus-leukemia reactions in the setting of autologous bone marrow transplantation by immunotherapy.

Bone Marrow Transplantation↗
PubMed1993

Autoantibodies in thalassaemia major: relationship with oral iron chelator L1.

Ninety patients with thalassaemia major were investigated for the occurrence of antinuclear antibodies (ANA), and those with ANA were tested for antibodies to histones (AHA). ANA were detected in 7 of 27 thalassemics on oral iron chelator L1, and in 2 of 63 thalassaemics not on L1 (p < 0.01). AHA were seen in 4 of 7 thalassemics receiving L1 with positive ANA, and in none of the 2 not receiving L1 (p < 0.03). Joint pains were seen in patients receiving L1, but in none of the patients not receiving L1. There was no correlation between hepatitis B or HIV positivity and presence of ANA or joint pains. While some amount of background ANA-positivity was found in patients with thalassaemia major, it was significantly more in patients receiving L1. Laboratory evidence of drug-induced lupus-like reaction was seen only in patients who received L1. In view of serious concerns about the safety of L1 and wide variations in the incidence and severity of adverse reactions reported by different sources, an urgent regulatory audit of all trial centres is essential.

Adolescent↗
PubMed1993

Cutaneous hypersensitivity to co-trimoxazole after autologus bone marrow transplantation and immunotherapy with interferon alpha-2A and interleukin-2.

Typical cutaneous hypersensitivity reaction to co-trimoxazole was seen in a woman after autologous bone marrow transplantation and immunotherapy. She had developed no such reaction during chemotherapy prior to the transplant or immediately after the transplant. The immunoperturbed state that exists for a period of time after bone marrow transplantation, especially in the presence of immunomodulation caused by combined therapy with recombinant human interferon alpha and interleukin-2, with exposure to potentially reaginic agents may have contributed to the development of the hypersensitivity reaction in this patient.

Adult↗
PubMed1993

Feasibility and efficacy of maintenance chemotherapy following autologous bone marrow transplantation for first remission acute lymphoblastic leukaemia.

Thirty-eight patients with poor risk ALL in first remission received maintenance chemotherapy following ABMT. Patients were conditioned for ABMT with high-dose melphalan and single fraction total body irradiation. Maintenance chemotherapy was commenced in a total of 26 patients and was tolerated to a median daily dose of 6-mercaptopurine of 40.5 mg/m2 and a median weekly dose of MTX 8.3 mg/m2. Twenty patients remain alive in first remission with a projected disease-free survival of 50% and a median follow-up in survivors of 200 weeks (range 48-387 weeks). Eleven patients have relapsed at a median of 4.5 months from ABMT. These patients were compared with remission patients with ALL receiving conventional chemotherapy on the United Kingdom Medical Research Council trials UKALL X and XA. After stratifying for major risk factors and allowing for the delay from remission to transplant, we have shown a significant reduction in the risk of relapse after ABMT (p = 0.04). Disease-free survival was not significantly increased due to transplant-related toxicity. This study suggests that maintenance chemotherapy to prevent relapse after ABMT for ALL is well tolerated and warrants assessment in a formal controlled trial.

Adolescent↗