جستجوی مقالات مرتبط با کلیدواژه « bone marrow transplantation » در نشریات گروه « پزشکی »

Donor cell-derived leukemia is a rare but well-described complication of allogeneic hematopoietic stem cell transplant (HSCT). This clinical case report aims to highlight the importance of recognizing this unusual disorder and thus, ensuring its appropriate management. We herein describe a case of a 9-year-old male diagnosed with acute lymphoblastic leukemia (ALL) and relapsed after initial chemotherapy. Subsequently, the patient had an allogenic peripheral blood stem cell transplant (PBSCT) from an HLA-matched, unrelated donor. Unfortunately, the patient then developed progressive thrombocytopenia and following investigation, including bone marrow examination and cytogenetic analysis, he was diagnosed with donor cell-derived myelodysplastic syndrome. The literature review emphasizes the importance of considering it as a differential diagnosis of disease relapse following allogeneic HSCT.

 Multiple myeloma (MM) management includes primary chemotherapy, followed by autologous bone marrow transplantation (ABMT) if the bone marrow gets cleared of cancerous cells. In some cases disease relapse may occur if complete clearance is not achieved. Transplantation was primarily performed through the bone marrow; however, peripheral blood has become more favored due to its safety and convenient collection in case of appropriate bone marrow mobilization which is a challenging issue.

 The current study was aimed to investigate the effectiveness of desipramine application for bone marrow mobilization in multiple myeloma (MM) who were candidate for autologous bone marrow transplantation (ABMT).

 The current randomized clinical trial involved 122 MM patients who were candidate for ABMT. The participants were divided into two intervention groups: the first group (n = 63) received G-CSF only treatment, while the second group (n = 59) received a similar G-CSF treatment plus desipramine. The first group received 30 microgram intravenous G-CSF for five days and the second one was treated with G-CSF with similar pattern in combination with daily 100 mg desipramine initiated within three days before G-CSF treatment and continued until the last dose of G-CSF. CD34+ cells and complete blood cells and differentiation were assessed by the end of the interventions.

 The findings of the study show that the number of CD34+ cells, white blood cells (WBC) and platelet (PLT) count were remarkably higher among the patients receiving the combination therapy compared to the G-CSF only treated group (P-value < 0.001) within 5 days after the interventions; however, no significant differences were observed between the two groups when considering the stage of the disease and the frequency of chemotherapy sessions (P-value > 0.05).

 Desipramine application led to significantly increased levels of CD34+ cells as the representatives of bone marrow mobilization. Besides, the patients treated with this regimen had higher serum levels of WBC and PLT; however, the disease stage and the number of chemotherapy sessions did not affect the response to the treatment.

Patients undergoing bone marrow transplantation (BMT) are at higher risk of immune system deficiency. The immunosuppression, followed by pre-transplant chemotherapy makes patients vulnerable to a variety of infections, and fever is one of the first symptoms, which could develop as a result of infectious or non-infectious diseases. In the present study, the features of the fever during the pre-engraftment stage in BMT receiving patients have been investigated.

Sixty-four patients receiving BMT were prospectively evaluated during the pre-engraftment phase to evaluate the evidence of the febrile reaction.  Data concerning the cause of fever, microbiological test, the treatments and fever onset pattern, and treatment outcomes were recorded and analyzed.

73.4% of the patients had an autologous transplant, and the others received allogeneic. After transplantation, 75% of patients encountered fever during the pre-engraftment period. Of the 48 patients, 47.9% of the patients suffered fever of unknown origin (FUO). Age, gender, underlying malignancy, type of transplantation, and acute phase reactants levels before transplantation were not associated with fever development. Among febrile patients, patients with autologous transplantation were significantly more likely to develop FUO (p-value = 0.036) There was also no significant difference in the onset of fever between patients with infectious fever and who suffered FUO.

During BMT, half of the patients developed a fever of unknown origin; nevertheless, it seems that patients undergoing allogeneic transplantation are at higher risk of FUO compared to patients who received an autologous transplant.

Hematopoietic stem cell transplantation strongly affects the care of patients suffering from malignant hematologic disorders and the implementation of interventions such as continuous care can affect the outcomes of treatment in a positive way. The aim of the current study was to determine the effect of implementing a continuous care model on self-care behavior in patients receiving HSCT between 2019 and 2020 in Shariati Hospital affiliated to Tehran University of Medical Sciences.

This semi-experimental study was conducted on 48 patients who were considered as candidates for HSCT at the Hematology, Oncology and Stem Cell Transplant Research Center, Shariati Hospital. Participants for the present study were selected by the continuous care model based on the inclusion criteria. A 4-stage continuous care model (CCM) developed was used as an intervention in the study. A valid and reliable assessment questionnaire designed to measure the self-care behaviors of the patient (PHLP2) was used for the collection of demographic information. It was completed in the first and fourth stages of implementing the continuous care model. Data were analyzed using SPSS 22 software (Chicago, IL, USA). Moreover, the Chi-square test, pair t-test, and independent samples t-test were used in this study.

There was no statistically significant difference between the intervention and control group in terms of demographic variables (p>0.05). Prior to intervention, no statistically significant difference was observed in the mean self-care score among HSCT patients in the intervention and control group (p=0.590), while, after the intervention, a statistically significant difference was observed in the mean self-care score among HSCT patients in the intervention and control group (p<0.001).

The study concluded that due to the increase in the number of patients undergoing HSCT across the country in recent years as well as the ease of implementation and low cost of this strategy to promote the self-care of HSCT recipients, relevant authorities ought to do it with the proper planning and policy nationwide. According to the results of the study, the use of a continuous care model on self-care behavior in patients receiving HSCT is recommended.

Chronic Granulomatous Disease (CGD) is a rare inherited primary immune deficiency disorder with defective respiratory burst activity in phagocytes, resulting in recurrent pyogenic infections. In this study, we described two CGD patients who had done bone marrow transplantation (BMT). As Bone marrow transplantation (BMT) is the definitive treatment of the disease, we evaluated the function of their lungs before and after BMT. In both patients, the BMT was from their siblings. In case 1, the patient’s pulmonary function (PFT) before BMT was: FEV1: 34, FVC: 40, FEV1 / FVC: 72%, and after BMT was: FEV1: 66, FVC: 40 by 49, FEV1 / FVC: 64%. In case 2, the patient’s PFT before BMT was: FEV1: 22, FVC: 36, FEV1 / FVC: 41%, and after BMT was: FEV1: 47, FVC: 33, FEV1/FVC: 43%. BMT significantly improved their Pulmonary Problems and Preclinical (PFT). In addition, after BMT, both patients’ well-tolerated clinical signs and the infection rate, and the number of hospitalizations in both patients decreased.

Despite close monitoring of transplant patients, cytomegalovirus (CMV) infection remains one of the most critical problems in the field of transplantation. This study aims to investigate the relationship between CMV viral load and clinical laboratory findings in transplant recipients.

Thirty-four transplant recipients comprising 15 kidney transplant (KT) recipients and 19 bone marrow transplant (BMT) recipients admitted to the Imam Reza Hospital in Kermanshah province, Iran were enrolled in this study. The CMV viral load was quantified by the real-time PCR technique.

The CMV viral load in KT recipients was significantly higher than in BMT recipients (p=0.03), and there was a positive association between the level of virus and the level of cyclosporine in the blood of patients ((r=0.51, p=0.02)). Besides, CMV viral load was positively correlated with WBC (r=0.32, p=0.04), urea (r=0.47, p=0.002), creatinine (r=0.39, p=0.01), AST (r=0.33, p=0.04), and LDH (r=0.4, p=0.01) and was negatively associated with albumin (r=-0.61, p<0.001), sodium (r=-0.4, p=0.01), and calcium levels (r=-0.46, p=0.003). There was also a meaningful difference in the CMV-related clinical laboratory findings between KT and BMT recipients, urea (p=0.02), creatinine (p=0.001), uric acid (p=0.005), direct bilirubin (p=0.04), albumin (p=0.04), platelet (p<0.001), and sodium (p=0.04) levels.

Based on present data, we conclude that despite careful monitoring of patients, infection with CMV is still one of the most important problems associated with organ transplantation, which is directly related to many laboratory findings.

There is a substantial amount of data provided in preclinical research and recently made early clinical efforts to evaluate the positive MSC therapy in Limb ischemia disease impacts. The present review is primarily focused on assessing various limb ischemia-related human MSC clinical trials to select the best technique with the highest limb ischemia-related clinical trial MSC efficacy. Five studies met the criteria to be included in this review. MSCs originating from bone marrow Allogenic MSC, bone marrow autogenous MSCs, HUCB MSCs were administered. The injection was intramuscular, Intravenous, and intravenous. The mean follow-up time was between 6 to 60months after MSC therapy. All studies reported improvement from baseline in at least 1 clinical outcome measure, and no study reported major adverse events attributable to MSC therapy. In clinical assessments, the selection of the best method could improve treatment efficacy. Several factors may be involved in the MSC injection efficacy of limb ischemia patients. Both allogeneic and autologous exhibited positive results over placebo. However, it is should be mentioned that autologous MSC investigation has higher cost and toxicity. To reduce the toxicity of derived MSCs while injection, particularly in arterial and intravenous injection, different injection doses can be performed. MI injection at different doses is the best method for diminishing the side effects. To evaluate injection efficacy, different criteria can be adopted, including angiography, ABI index, ulcer healing and amputation, and pain-free walking distance follow-up for up to five years.

Context: 

Infections are a major cause of disease and mortality in transplant recipients. Despite the studies conducted in Iran, no comprehensive and general research is available in this area. The present study aimed to determine the frequency of infectious agents in patients after bone marrow transplantation in Iran.

 In this systematic review, relevant studies were selected based on type and objective, and data were collected from the articles published in Iran regarding the frequency of infectious agents after bone marrow transplantation in different regions of Iran. The studies were collected using systematic search methods.

 In total, 11 studies were identified regarding infectious agents after bone marrow transplantation. Six studies were conducted in Tehran, three studies were performed in Shiraz, and Mashhad and Semnan provinces were the locations of two separate studies. Most of the case studies identified viral agents (54.5%; n = 6), followed by fungal infectious agents (27.3%; n = 3) and bacterial agents (18.2%; n = 2). Gram-positive bacteria (bacterial agents), cytomegalovirus (viral agents), and Candida and Aspergillus (fungi) had the highest frequency after bone marrow transplantation.

 According to the results, viral, fungal, and bacterial infectious agents were respectively most frequent in patients receiving bone marrow transplants. Gram-positive bacteria (bacterial agents), cytomegalovirus (viral agents), and Candida and Aspergillus (fungi) had the highest frequency after bone marrow transplantation.

Krabbe disease (KD) or globoid cell leukodystrophy (GLD) is one of the lysosomal disorders affecting central and peripheral nervous systems (CNS and PNS). It is caused by mutations on the galactocerebrosidase (GALC) gene. Affected individuals accumulate undegraded substrates and suffer from neuroinflammation.

Hematopoietic stem cell transplantation (HSCT) has been partially successful in treating patients with KD when accomplished prior to the onset of symptoms. The success is credited to the ability of the hematopoietic stem cells in providing some GALC enzyme to the CNS and eradicating potential neuroinflammation. Combination of the HSCT with some other GALC-providing strategies has shown synergistic effects in the treatment of the mouse model of this disease.

Here, the possibility of eliminating HSCT in the treatment of human patients and replacing it with a single therapy that will provide sufficient GALC enzyme to the nervous systems is suggested. Such treatment, if started during the asymptomatic stage of the disease, not only may eradicate the enzyme deficiency, but may also keep any neuroinflammation at bay.

Successful treatment of the KD may be possible by restoring consistent and sufficient GALC expression in CNS and PNS.

A 14-year-old boy with a past medical history of bone marrow transplantation (BMT) was referred to the emergency department with the loss of consciousness and seizure. On admission, the blood test indicated strict hyponatremia with hypokalemia, hypomagnesemia, hypophosphatemia, hypoglycemia, and low-serum low-density lipoprotein cholesterol (LDL-C). After six days, the patient suffered from dysarthria, dysphagia, behavioral disturbances, disorientation, and obtundation. Based on the physical examination, hyperreflexia and upward bilateral plantar reflexes were outstanding. Lumbar puncture, spiral brain CT scan, and MRI were normal. Hence, MRI repeated 2 weeks later, and the T2-weighted image indicated the bilateral symmetric hyperintense lesions in the basal ganglia. The osmotic demyelination syndrome (ODS) is a scarce and serious neurologic complication of the quick correction of chronic strict hyponatremia.

Krabbe disease (KD) is an autosomal recessive disorder caused by mutations in the galactocerebrosidase (GALC) gene resulting in neuro-inflammation and defective myelination in the central and peripheral nervous systems. Most infantile patients present with clinical features before six months of age and die before two years of age. The only treatment available for presymptomatic or mildly affected individuals is hematopoietic stem cell transplantation (HSCT). In the animal models, combining bone marrow transplantation (BMT) with gene therapy has shown the best results in disease outcome. In this study, we examine the outcome of gene therapy alone.

Twitcher (twi) mice used in the study, have a W339X mutation in the GALC gene. Genotype identification of the mice was performed shortly after birth or post-natal day 1 (PND1), using polymerase chain reaction on the toe clips followed by restriction enzyme digestion and electrophoresis. Eight or nine-day-old affected mice were used for gene therapy treatment alone or combined with BMT. While iv injection of 4 × 1013 gc/kg of body weight of viral vector was used originally, different viral titers were also used without BMT to evaluate their outcomes.

When the standard viral dose was increased four- and ten-fold (4X and 10X) without BMT, the lifespans were increased significantly. Without BMT the affected mice were fertile, had the same weight and appearance as wild type mice and had normal strength and gait. The brains showed no staining for CD68, a marker for activated microglia/macrophages, and less astrogliosis than untreated twi mice.

Our results demonstrate that, it may be possible to treat human KD patients with high dose AAVrh10 without blood stem cell transplantation which would eliminate the side effects of HSCT.

Nonunion is a serious complication following long-bone fracture that is known as a therapeutic challenge for surgeons and is associated with significant morbidity. It has been shown that osteogenesis stimulating factors combined with optimization of the mechanical environment could facilitate and accelerate nonunion healing. In this study, we aimed to treat nonunion using autologous bone marrow-derived mononuclear cell (BMDMC) aspirate as a source of osteoprogenitor cells combined with internal fixation.

From November 2010 to May 2013, 19 cases of nonunion were treated with bone marrow-derived mononuclear cell (BMDMC) grafting, that included 15 males and 4 females with an average age of 37.8 years (range, 18-81 years). The time from injury to therapy was 7 to 28 months, with an average of 13.4 months. At first, decortications were performed around the nonunion site to prepare a suitable bed for bone marrow grafting. Then, 2 ml of bone marrow concentrated cells was applied to the nonunion site in a mixture with partially demineralized cortical cancellous allograft chips. The healing rate in each patient was clinically and radiologically evaluated every 4 weeks.

Bone union was obtained in 18 of the 19 patients during 1.06 to 6 months with an average time of 3.5 months. No complications during anesthesia nor any infection, hematoma or chronic pain at the nonunion site were observed in any patient.

Transplantation of autologous BMDMC aspirate is a reasonable, effective and easy treatment option for tibial and femoral nonunion after internal fixation.

Oral mucositis is among the most important adverse effects of chemotherapy and bone marrow transplantation and prevention from this side effect is important to improve the situations in patients. Hence, in this study the main aim was to determine the effects of low-level laser therapy on mucositis in patients under chemotherapy and bone marrow transplantation.

In this randomized controlled clinical trial, 60 consecutive patients under chemotherapy and bone marrow transplantation in a training hospital in 2018 were enrolled and randomly assigned to receive either low-level laser therapy (630 and 780 nm) or off-laser. Finally, the frequency rate and severity of mucositis (grades 0 to 4 according to WHO severity index) were determined and compared across the groups.

Mucositis was present in 30% and 56.7% in laser and control groups, respectively with statistically significant difference (p=0.037). The severity of mucositis was same across the laser and control groups (p=0.785).

Low-level laser therapy is an effective modality for preventing from mucositis in patients treated by chemotherapy and bone marrow transplantation. Accordingly, utilization of this safe and effective therapeutic method is recommended.

Krabbe disease (KD) is an autosomal recessive lysosomal disorder caused by mutations in the galactocerebrosidase (GALC) gene. This results in defective myelination in the peripheral and central nervous systems due to low GALC activity. Treatment at this time is limited to hematopoietic stem cell transplantation (HSCT) in pre-symptomatic individuals. While this treatment extends the lives of treated individuals, most have difficulty walking by the end of the first decade due to peripheral neuropathy. Studies in the murine model of KD, twitcher (twi) combining bone marrow transplantation (BMT) with AAVrh10-mGALC showed a great extension of life from 40 days to about 400 days, with some living a full life time.

In order to find the optimum conditions for dosing and timing of this combined treatment, twi mice were injected with five doses of AAVrh10-mGALC at different times after BMT. Survival, as well as GALC expression were monitored along with studies of sciatic nerve myelination and possible liver pathology.

Dosing had a pronounced effect on survival and measured GALC activity. There was window of time after BMT to inject the viral vector and see similar results, however delaying both the BMT and the viral injection shortened the lifespans of the treated mice. Lowering the viral dose too much decreased the correction of the sciatic nerve myelination. There was no evidence for hepatic neoplasia.

These studies provide the conditions optimum for successfully treating the murine model of KD. There is some flexibility in dosing and timing to obtain a satisfactory outcome. These studies are critical to the planning of a human trial combining the "standard of care", HSCT, with a single iv injection of AAVrh10-GALC.

Reactivation of BK virus (BKV), viremia is a major clinical complication in transplant recipients. There are many studies of BKV infection among tissue transplant recipients, especially renal-transplant recipients. Although the presence of BKV in patients’ urine occurs frequently, the detection of BKV in the blood of transplant recipients, especially after bone marrow transplantation (BMT), is less studied. The aim of this study was to detect BKV in 54 blood samples of BMT recipients in the first days after transplantation. This case-control study was performed in a university-affiliated hospital, Tehran, Iran, from October 2017 to October 2018. Blood samples were collected from 54 hematopoietic stem cell transplant recipients, and 54 healthy subjects without any tissue transplantation, and tested daily for BKV DNA using the quantitative real-time PCR technique. In this study, two patients (3.7%) developed BK viremia at a median of 10 days (range: 1 - 10 days) after BMT, while none of the control subjects was positive for BKV in blood samples. The analysis of data showed no significant difference between the case and control groups (CI: 0.986 - 1.094, P < 0.153). Our data suggest that BKV viremia involved in active infection may not occur in the first days after BMT. This finding can affect controlling and managing BMT patients.