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PubMed1995

Allogeneic bone marrow transplantation for lysosomal storage diseases. The European Group for Bone Marrow Transplantation.

Patients with lysosomal storage disorders have visceral, skeletal, and neurological abnormalities and a limited life expectancy. Bone marrow transplantation has been used to correct the metabolic defects and leads to metabolic improvements in most patients. However, the long-term effect of such therapy is uncertain. We analysed the data from 63 patients transplanted for lysosomal storage diseases. The transplant-related mortality was 10% if an HLA-identical sibling marrow donor was available (n = 40) and 20-25% if mismatched tissue was used. Data on the effect of bone marrow transplantation on biochemical and clinical disease variables were available in 29 of the 63. 28 had a follow-up duration of 1.0-10.2 years; 1 patient died of disease progression in the first year after stable engraftment. 13 patients who had severe neurological symptoms at the time of transplantation showed disease progression. Engraftment of bone marrow in 5 patients with non-neuronopathic Gaucher's disease led to complete disappearance of symptoms. 11 patients had skeletal symptoms because of various mucopolysaccharidoses (MPSs). There was stabilisation of the skeletal lesions during the observation period of 1.4-6.4 years, but none of the patients showed significant regression of the skeletal symptoms. The visceral features (hepatosplenomegaly, cardiac hypertrophy, and upper airway obstruction) in these patients abated after transplantation. We could not evaluate the biochemical and clinical variables in 34 patients because of graft rejection, transplant-related mortality, or follow-up of less than 1 year. There were significant beneficial effects of bone marrow transplantation in patients with non-neuronopathic Gaucher's disease. Stabilisation of disease was observed in patients with MPS-I and MPS-II; this potential benefit needs to be confirmed by longer follow-up. Bone marrow transplantation was not effective if severe neurological symptoms were already present at the time of transplantation.

Adolescent↗
PubMed1986

Differential effects of phorbol esters on normal myeloid precursors and leukemic cells: basis for autologous bone marrow reconstitution in acute nonlymphocytic leukemia using phorbol ester-treated bone marrow from patients in remission.

The phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA) induces macrophage-like differentiation of HL60 cells and cells from patients with acute nonlymphocytic leukemia (ANLL). We assessed the use of TPA as a means of eradicating residual leukemia from remission bone marrow prior to autologous bone marrow reconstitution. A 30-min incubation with TPA led to marked growth arrest in HL60 cells and in cells from most patients with acute myelogenous leukemia and acute myelomonocytic leukemia, whereas cells from most patients with acute promyelocytic leukemia and acute undifferentiated leukemia demonstrated a lesser degree of growth arrest. Freezing and thawing, a necessary step in autologous reconstitution, had no effect on the cessation of proliferation induced in HL60 or ANLL cells preincubated with TPA for 30 min. Virtually normal myeloid precursor growth occurred in normal or remission bone marrow cells preincubated with TPA and then frozen and thawed. Based on these observations, two patients with advanced ANLL in remission underwent marrow ablative therapy followed by autologous reconstitution using TPA-treated bone marrow. Limited normal hematopoiesis was reestablished in both patients, although they subsequently experienced leukemic relapse. These studies demonstrate that in ANLL cells, TPA stimulates growth arrest; in contrast, hematopoiesis is able to proceed both in vitro and in vivo.

Bone Marrow↗
PubMed1985

Oral manifestations of bone marrow transplantation.

Bone marrow protection by transplantation permits the administration of large doses of antitumor drugs and radiation. Severe oral complications occur in about 70% of patients who have had allogeneic bone marrow transplants and to a lesser degree in patients who have had autologous and syngeneic transplants. Oral complications consist of mucositis, salivary gland dysfunction, loss of resiliency of perioral tissues, periodontal disease, and caries. Pre- and post-transplant oral care aimed at plaque control, control of dental pathology, and hydration of oral tissues are important factors in support therapy of bone marrow transplant patients.

Adolescent↗
PubMed1988

Evolution of consultation-liaison services in bone marrow transplantation.

Bone marrow transplantation offers new hope for cure in a variety of leukemias, aplastic anemia, and other immunodeficiency and hematologic disorders. But the psychologic circumstances accompanying this procedure are often profoundly stressful. The evolution of consultation--liaison services on a bone marrow transplantation unit are described and illustrated with several clinical vignettes. The results of a survey of 52 other bone marrow transplantation centers report the percentage that provide such services and the extent to which they are performed by a psychiatrist, a nonphysician psychosocial counselor, or both.

Adaptation, Psychological↗
PubMedDate not supplied

The use of G-CSF and GM-CSF in bone marrow transplantation.

Bone marrow transplantation is accepted as potentially curative therapy for a variety of patients with hematologic malignancies and other disorders. The most important causes of morbidity are infections and bleeding secondary to prolonged cytopenias. Granulocyte colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) have been shown to potentially enhance bone marrow engraftment which has translated into reduced morbidity and mortality. Additionally, growth factors such as G-CSF and GM-CSF may increase numbers of circulating peripheral progenitor cells to serve as the source of "marrow" for transplantation. This review summarizes the current available data using G-CSF and GM-CSF in bone marrow transplantation and discusses potential areas of study with additional cytokines.

Bone Marrow Transplantation↗
PubMed1995

Haematopoietic growth factors in the treatment of therapeutic and accidental irradiation-induced bone marrow aplasia.

Bone marrow aplasia is one of the main syndromes following a high dose accidental exposure of ionizing radiation. Although both transfusion and bone marrow transplantation have been used with some success since the first treatments of patients, other therapeutic strategies are needed. The strategies involving haematopoietic growth factors for the treatment of radiation victims have been explored in vivo mainly in animal models and it is hoped that new therapeutic regimens will be elucidated from such approaches. The growth factors stimulate proliferation and/or differentiation of haematopoietic progenitor cells and possible stem cells. Furthermore, they act on the functions of mature cells. They now have specific uses in haematology, related to their role in the regulation of growth and differentiation of haematopoietic progenitor cells. The results of the clinical trials, performed with numerous patients and often randomized bring important clues about what to expect from growth factor therapy. Other factors are only entering the preclinical or clinical trials now. Although numerous in vitro or in vivo experiments suggest a benefit from their effects, their possible uses in therapy are still questionable. Some growth factors have already been used for the treatment of accidental radiation-induced aplasia and lessons have been learned from their medical management and follow-up.

Accidents↗
PubMed1983

Derivation of lymphoma cell lines from microscopically normal bone marrow in patients with undifferentiated lymphomas: evidence of occult bone marrow involvement.

Evidence is presented that at least 17% of microscopically normal bone marrow samples obtained from patients with undifferentiated lymphomas contain occult tumor cells. Of 19 microscopically normal bone marrow samples tested, continuous tumor cell lines were obtained from 4. A tumor cell origin was confirmed by the presence of an 8;14 chromosomal translocation in each case, and HLA typing confirmed the patient origin of the cell line. In two other patients, direct cytogenetic examination of microscopically normal bone marrow samples revealed karyotypes containing 8:14 translocations or a 14q+ chromosome. These findings indicate that undifferentiated lymphomas are often more widespread than is clinically appreciated. The presence of submicroscopic marrow involvement is also of significance to the design and analysis of treatment protocols involving autologous marrow infusion.

Adult↗
PubMed2002

Iron-oxide-enhanced MR imaging of bone marrow in patients with non-Hodgkin's lymphoma: differentiation between tumor infiltration and hypercellular bone marrow.

The aim of this study was to differentiate normal, hypercellular, and neoplastic bone marrow based on its MR enhancement after intravenous administration of superparamagnetic iron oxides in patients with cancer of the hematopoietic system. Eighteen patients with cancer of the hematopoietic system underwent MRI of the spine before and after infusion of ferumoxides ( n=9) and ferumoxtran ( n=9) using T1- and T2-weighted turbo spin-echo (TSE) and short tau inversion recovery sequences (STIR). In all patients diffuse or multifocal bone marrow infiltration was suspected, based on iliac crest biopsy and imaging such as conventional radiographs, MRI, and positron emission tomography. In addition, all patients had a therapy-induced normocellular ( n=7) or hypercellular ( n=11) reconversion of the normal non-neoplastic bone marrow. The MRI data were analyzed by measuring pre- and post-contrast signal intensities (SI) of hematopoietic and neoplastic marrow and by calculating the enhancement as deltaSI(%) data and the tumor-to-bone-marrow contrast as contrast-to-noise ratios (CNR). Changes in bone marrow signal intensity after iron oxide administration were more pronounced on STIR images as compared with T1- and T2-weighted TSE images. The STIR images showed a strong signal decline of normal and hypercellular marrow 45-60 min after iron oxide infusion, but no or only a minor signal decline of neoplastic bone marrow lesions; thus, deltaSI% data were significantly higher in normal and hypercellular reconverted marrow compared with neoplastic bone marrow lesions ( p<0.05). Additionally, the contrast between focal or multifocal neoplastic bone marrow infiltration and normal bone marrow, quantified by CNR data, increased significantly on post-contrast STIR images compared with precontrast images ( p<0.05). Superparamagnetic iron oxides are taken up by normal and hypercellular reconverted bone marrow, but not by neoplastic bone marrow lesions, thereby providing significantly different enhancement patterns on T2-weighted MR images; thus, superparamagnetic iron oxides are useful to differentiate normal and neoplastic bone marrow and to increase the bone marrow-to-tumor contrast.

Adult↗
PubMed1999

Glutamine in the support of patients following bone marrow transplantation.

Bone marrow transplantation is being utilized with increasing frequency in the treatment of patients with malignancy; it is also being applied to the treatment of patients with genetic diseases and as an adjunct to solid organ transplantation. The high dose cytotoxic chemotherapy, often accompanied by total body irradiation, results in severe catabolism, disruption of the gastrointestinal mucosa and marked immunosuppression. A variety of studies show that the supplementation of the amino acid glutamine, by the enteral or parenteral route, as either the free or dipeptide form, appears safe and efficacious in patients undergoing bone marrow transplantation. Further double-blind controlled clinical trials of glutamine supplementation in patients undergoing bone marrow transplantation and receiving more contemporary treatment, which often includes the administration of novel combinations of cytoreductive agents and hematopoietic growth factors, are warranted.

Administration, Oral↗
PubMed1992

Comparison of oxidant-generation and BP-diol activation by bone marrow cells from C57Bl/6 and DBA/2 mice: implications for risk of bone marrow toxicity induced by polycyclic hydrocarbons.

Neutrophil-derived oxidants have been implicated in both the damage to biomolecules and the metabolic activation of xenobiotics. Bone marrow, a relatively neutrophil-rich tissue with low cytochrome P450 activity, is subject to toxicity from orally administered benzo[a]pyrene (BP) in mice with noninducible P450 monooxygenase systems. Thus, we have compared the oxidant generation and chemical activation by neutrophilic cells isolated from femurs of male DBA/2 and C57Bl/6 mice, strains that are susceptible and nonsusceptible, respectively, to bone marrow toxicity from BP. Oxidant generation of neutrophilic preparations was assayed by superoxide anion generation and oxidant-dependent chemiluminescence (CL) from luminol or lucigenin. In all assays, cells from DBA/2 mice demonstrated increased oxidant generation. CL from BP-7,8-dihydrodiol (BP-diol) has previously been shown to correlate with its ability to elicit genotoxic effects. A twofold enhancement of oxidant-dependent CL from BP-diol was observed with TPA-stimulated neutrophilic cells from DBA/2 mice as compared to cells from C57Bl/6 mice. DBA/2-derived bone marrow cells also activated more BP-diol to a DNA covalent binding species than did bone marrow cells derived from the less BP-sensitive C57Bl/6 mouse. Tetraol analysis of BP-diol metabolism by activated bone marrow cells confirmed this greater bioactivation of the diol by DBA/2-derived cells. These results suggest that the increased risk of DBA/2 mice for BP-induced bone marrow toxicity may be related to their greater ability to bioactivate xenobiotics through oxidant-dependent mechanisms.

Acridines↗
PubMed1998

[Optimizing plasma cell content in bone marrow aspirates].

Bone marrow samples used for flow cytometric analysis of plasma cells frequently provide a low plasma cell content. Regularly, samples used for flow cytometry are provided by second step aspiration while the first aspirate is used for cytologic examination. We investigated whether the use of secondary aspirates leads to a systematic underestimation of the bone marrow plasma cell content as a consequence of an increased blood contaminant. To test the hypothesis, plasma cell (CD38bright) percentages were established by flow cytometry in 13 pairs of primary/secondary aspirates. In all cases we found lower plasma cell contents in secondary as compared to primary aspirates (p = 0.0015). Median plasma cell counts in secondary aspirates were 57% lower compared to primary aspirates. We conclude that the use of secondary aspirates leads to systematic underestimation of the bone marrow plasma cell content.

Bone Marrow↗
PubMed1995

Tonsil lymphoma presenting as tonsillitis after bone marrow transplantation.

Bone marrow transplantation for the treatment of leukemia is increasingly successful in rendering patients disease free. However, it has become evident that the associated severe immunosuppression predisposes this population to an increased risk for other neoplastic disorders. We report on six patients in whom non-Hodgkin's lymphoma of the tonsillar region developed within 5 months after T-cell-depleted bone marrow transplantation for the treatment of leukemia at Memorial Sloan-Kettering Cancer Center from October 1990 to October 1992. These patients initially had what appeared to be infectious exudative pharyngitis/tonsillitis; however, they did not improve with medical therapy. Because of the persistence of pharyngitis/tonsillitis in association with cervical lymphadenopathy and odynophagia, the patients underwent definitive biopsy in the form of tonsillectomy, cervical lymph node biopsy, or both. Histopathologic review revealed non-Hodgkin's lymphoma. An association with Epstein-Barr virus has been noted in five of these patients. This article is aimed at alerting the clinician to consider the diagnosis of lymphoma in a patient with persistent pharyngitis/tonsillitis despite adequate medical therapy after bone marrow transplantation.

Adult↗
PubMed2001

[Allogenic hematopoietic stem cell transplantation in acquired aplastic anemia: first experience of the National Center for Bone Marrow Grafting].

Bone marrow transplantation from HLA-identical sibling offers cure and leads to restoration of normal hematopoiesis and long-term survival in 60-80% of recipients. From february 1998 to october 1999, seven patients with aplastic anemia (2 very severe aplastic anemia and 5 severe aplastic anemia), with a median age of 22 years (14-39), received a transplant from an HLA-identical sibling donor. All patients had sustained engraftment. Only one patient developed grade IV acute graft-versus-host disease. One patient died in the 22th day of systemic mycobacterial infection and one in the 79th day of acute graft-versus-host disease. The remaining 5 patients are alive and have a complete hematological recovery, with a median follow-up of 6 months (1,5-12). There are at least two reasons for the improved survival of patients with aplastic anemia who where treated by HLA-indentical bone marrow transplantation. One is the decreased incidence of graft rejection that has resulted from the more judicious use of transfusions before bone marrow transplantation, and improvements in the immunosuppressive qualities of the conditioning programs. Another reason for improved survival is the decrease in the incidence and severity of acute graft-versus-host disease.

Adolescent↗
PubMed2006

Inhaled nitrous oxide (Entonox) as a short acting sedative during bone marrow examination.

Bone marrow aspiration and biopsy is a procedure of central importance in the diagnosis of haematological disease and is one that can be safely performed in the outpatient clinic using only local anaesthesia. We evaluated the role of inhaled nitrous oxide (Entonox) as an adjuvant to local anaesthesia (LA) in patients requiring bone examination. We prospectively studied the role of Entonox in patients attending our outpatient department who required bone marrow examination. All patients received LA with injected 2% lignocaine but patients were then assigned to either LA alone or LA plus inhaled Entonox. Following the procedure patients were given a questionnaire and asked to score the discomfort associated with the procedure. Twenty-eight of 85 patients (33%) who received LA alone scored their pain as 3 (severe) compared with seven of 51 patients (14%) who received LA plus Entonox, P = 0.013. No adverse events were associated with Entonox use. Forty-three of the 51 patients who received Entonox stated that they would prefer to use this method of anaesthesia again. We conclude that inhaled Entonox is a useful adjuvant to local anaesthesia for patients undergoing bone marrow examination.

Administration, Inhalation↗
PubMed1988

Bone marrow cryopreservation and clinical implications in autologous bone marrow transplantation.

A simple, rapid and effective technique using the IBM (Cobe)-2991 cell processor for the concentration of buffy coat cells from large volume marrow has been well adopted (n = 16). Only about one-eighth of the original volume was obtained while retaining more than 90% of the total nucleated cells to be cryopreserved in polyolefine bags with TC-199 culture medium and final 10% dimethylsulfoxide (DMSO) (n = 9), processed by a computerized Nicool ST-20 (France) programmed freezer and stored in a vapor phase of liquid nitrogen at -196 degrees C. Stem cell assay by CFU-GM after thawing yielded a mean of 50.39 +/- 19.54% which has been satisfactory for clinical implementation. So far, three cases with hematological malignancies had been rescued by autologous cryopreserved marrow after supralethal doses of chemoradiotherapy. Two patients with acute nonlymphocytic leukemia transplanted in 1st remission as of Oct. 31 had been disease free for 178+ and 157+ days, respectively, after transplant which was taken at the corresponding age of 53 and 42 years. The other patient who was a victim of Hodgkin's disease, stage IV, and was transplanted in 3rd remission, expired on the 59th day because of the complication of idiopathic interstitial pneumonitis despite excellent granulocytopoietic reconstitution. The preliminary results are encouraging for further exploitation, especially for those who would otherwise be candidates for allogeneic bone marrow transplantation but are limited by age or lack of an HLA-identical sibling to serve as marrow donors.

Adult↗
PubMed1979

Differentiation of functionally active mouse T lymphocytes from functionally inactive bone marrow precursors. IV. Recovery of T-cell function from bone marrow precursors in a histo-incompatible environment.

Regeneration of T-cell activities in vivo or in vitro from mouse bone marrow precursors differentiating in the presence of an allogeneic thymus was investigated. The data indicated that T-depleted bone marrow cells fail to affect long-term reconstitution of allogeneic recipients unless a pool of rapidly maturing T-precursor cells is also removed (post-thymic pool). Animals reconstituted with pre-thymic bone marrow stem cells become stable chimaeras in which cells capable of generating an in vitro CML response to host antigens, as well as cells capable of suppressing that response, could be demonstrated. Similar data (CML directed against the H-2 antigens of the 'host' thymus feeder layer and cells capable of inhibiting that response) were obtained when pre-thymic bone marrow cells were grown in vitro on allogeneic thymus feeder cells. When cytotoxic T-lymphocyte precursor (CTLp) and helper (CTLh) cells were separately investigated, a restriction in their co-operation for an anti-host response was observed when precursor cells differentiated in an allogeneic environment. Only CTLp and CTLh differentiating in the presence of the same allogeneic thymus source (whether in vivo or in vitro) could co-operate to generate CTL directed to H-2 antigens of that thymus source.

Animals↗
PubMed2000

A novel subset of murine B cells that expresses unmasked forms of CD22 is enriched in the bone marrow: implications for B-cell homing to the bone marrow.

CD22 is a B-cell-restricted transmembrane protein, which acts as a negative regulator of B-cell signalling. CD22 also has lectin-like adhesive properties. When expressed on transfected fibroblasts, it is capable of mediating adhesion to other cells via recognition of cell-surface glycoconjugates terminating in alpha2,6-linked sialic acids. In previous studies in the mouse, CD22 was implicated as a bone marrow homing receptor for recirculating immunoglobulin D+ (IgD+) B cells through recognition of sialylated ligands on marrow sinusoidal endothelium. As the adhesive function of CD22 can be masked when alpha2,6-linked sialic acids are co-expressed at the cell surface, the aim of the present study was to investigate whether recirculating B cells have unmasked forms of CD22 that could be involved in bone marrow homing. Using alpha2,6-sialyllactose coupled to biotinylated polyacrylamide as a probe for detection of unmasked CD22, we showed that approximately 2-5% of IgD+ murine B cells in the spleen and mesenteric lymph nodes were able to bind this synthetic ligand. In the bone marrow, however, the fraction of IgD+ B cells with unmasked CD22 was increased by two- to fivefold. B cells from CD22-deficient mice were not stained with the polyacrylamide probe, confirming that staining of B cells in wild-type mice was caused by CD22 and not by other potential sialic acid-binding lectins. In conclusion, we have identified a new subset of mature B cells in the mouse with unmasked CD22. This subset of recirculating B cells may bind to CD22 ligands on bone marrow sinusoidal endothelium, leading to their selective homing and subsequent enrichment in this tissue.

Animals↗