| Microangiopathy following allogeneic marrow transplantation. Association with cyclosporine and methylprednisolone for graft-versus-host disease prophylaxis. | |
| | |
MedLine Citation:
|
PMID: 7491699 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
A microangiopathic syndrome was observed in 3 of 14 (21%) patients receiving cyclosporine and methylprednisolone (CSA-MP) for graft-versus-host disease (GVHD) prophylaxis between January 1991 and June 1992 at our center. The syndrome consisted of neurological abnormalities, arterial hypertension, intravascular hemolysis with red cell fragmentation, and a drop in platelet counts after allogeneic bone marrow transplantation (BMT) for hematological malignancy, and it occurred around day 50 after BMT. Treatment with plasma exchanges against fresh-frozen plasma resulted in a decrease of serum lactate dehydrogenase and an improvement of neurological symptoms. We compared CSA-MP patients retrospectively with patients who had received cyclosporine and methotrexate (CSA-MTX) for GVHD prophylaxis (n = 70) at our institution. All patients in both groups engrafted. Day 100 survival (80% vs. 79%) and transplant-related mortality (16% vs. 14%) were identical in the two groups. CSA-MP patients had significantly more acute GVHD II-IV (57% vs. 17%, P < 0.01). Arterial hypertension (P < 0.01) and neurological symptoms (P < 0.01) were significantly more frequent in the CSA-MP group. The 11 asymptomatic CSA-MP patients had significantly higher lactate dehydrogenase levels (P < 0.01) and lower platelet counts (P < 0.01) at 40, 60, and 100 days after BMT, which suggests the presence of a subclinical form of microangiopathy. Significantly higher plasma levels of von Willebrand factor antigen in CSA-MP patients on day 50 after BMT (P < 0.05) and absence of large von Willebrand factor multimers on gel electrophoresis in 4 of 13 (31%) CSA-MP patients compared with 0 of 14 (0%) CSA-MTX patients (P < 0.01) further suggest profound endothelial damage in patients receiving CSA-MP for GVHD prophylaxis. |
| | |
Authors:
|
P Kalhs; S Brugger; I Schwarzinger; H T Greinix; F Keil; P A Kyrle; P Knöbl; B Schneider; P Höcker; W Linkesch |
Related Documents
:
|
14684669 - Cardiovascular and renal risk assessment as a guide for treatment in primary hypertension. 8161259 - Surgical treatment of primary hyperaldosteronism. 2142489 - Improved results with surgical treatment of renovascular hypertension: an individualize... 16256009 - Primary aldosteronism: diagnostic and therapeutic considerations. 16127209 - The evaluation of left ventricular hypertrophy in hypertensive patients with subclinica... 1188529 - Prazosin in the treatment of hypertension: a preliminary study. 16699279 - Infliximab therapy improves the bone metabolism in fistulizing crohn's disease. 11436069 - Lepirudin is a safe and effective anticoagulant for patients with heparin-associated an... 20555049 - Clinical characteristics of people with head nodding in southern tanzania. |
Publication Detail:
|
Type: Comparative Study; Journal Article |
Journal Detail:
|
Title: Transplantation Volume: 60 ISSN: 0041-1337 ISO Abbreviation: Transplantation Publication Date: 1995 Nov |
Date Detail:
|
Created Date: 1996-01-03 Completed Date: 1996-01-03 Revised Date: 2006-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0132144 Medline TA: Transplantation Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 949-57 Citation Subset: IM |
Affiliation:
|
Medical Department I, University of Vienna, Austria. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Bone Marrow Transplantation / immunology* Cyclosporine / adverse effects*, therapeutic use Female Follow-Up Studies Graft Survival Graft vs Host Disease / prevention & control* Hemolysis* Humans Hypertension / etiology, physiopathology* Immunosuppressive Agents / adverse effects*, therapeutic use L-Lactate Dehydrogenase Male Methotrexate / therapeutic use Methylprednisolone / adverse effects*, therapeutic use Middle Aged Nervous System Diseases / etiology, physiopathology* Plasmapheresis Platelet Count Retrospective Studies Syndrome Transplantation, Homologous Vascular Diseases / chemically induced* |
| Chemical | |
Reg. No./Substance:
|
0/Immunosuppressive Agents; 59-05-2/Methotrexate; 59865-13-3/Cyclosporine; 83-43-2/Methylprednisolone; EC 1.1.1.27/L-Lactate Dehydrogenase |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Elevated inflammatory cytokine levels in bone marrow graft rejection.
Next Document: Mycobacterium haemophilum infections in bone marrow transplant recipients.