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Epstein-Barr viral load and disease prediction in a large cohort of allogeneic stem cell transplant recipients.

https://arctichealth.org/en/permalink/ahliterature160576
Source
Clin Infect Dis. 2007 Nov 15;45(10):1305-9
Publication Type
Article
Date
Nov-15-2007
Author
S M Aalto
E. Juvonen
J. Tarkkanen
L. Volin
H. Haario
T. Ruutu
K. Hedman
Author Affiliation
Department of Virology, Haartman Institute, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
Source
Clin Infect Dis. 2007 Nov 15;45(10):1305-9
Date
Nov-15-2007
Language
English
Publication Type
Article
Keywords
Cohort Studies
DNA, Viral - blood
Epstein-Barr Virus Infections - diagnosis - epidemiology - virology
Finland - epidemiology
Herpesvirus 4, Human - isolation & purification
Humans
Polymerase Chain Reaction
Retrospective Studies
Stem Cell Transplantation - adverse effects
Transplantation
Transplantation, Homologous - adverse effects
Viral Load
Abstract
We wanted to determine the clinical significance and predictability of Epstein-Barr virus (EBV) infections among a large cohort of recipients of allogeneic, unselected stem cell transplants.
During 1988-1999, a total of 5479 consecutive serum samples obtained during 406 transplantations performed in Helsinki, Finland, were retrospectively analyzed by quantitative polymerase chain reaction for the presence of EBV DNA.
Overall, EBV DNA was noted in at least 1 serum sample for 57 patients (14.0%), of whom 22 (5.4%) were found to have progressively increasing and ultimately high (>50,000 copies/mL) EBV DNA levels (median level, 179,000 copies/mL). In addition, 16 patients (4.0%) had low EBV DNA levels (median level, 3260 copies/mL) in isolated sera before death. Among the transplant recipients who survived, transient EBV DNAemia (median level, 3110 copies/mL), which apparently corresponded to asymptomatic EBV infection, was noted in 19 patients (4.7%).
Low-level EBV DNA positivity in serum occurs relatively frequently after stem cell transplantation and may subside without specific treatment. However, high EBV DNA levels (i.e., >50,000 copies/mL) are strong predictors for the development of posttransplantation lymphoproliferative disease, are not spontaneously reversible, and should be treated immediately. If the EBV DNA level is >or=50,000 copies/mL, the patient can be classified as having life-threatening EBV infection.
PubMed ID
17968825 View in PubMed
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Failure to prevent cytomegalovirus infection by cytomegalovirus hyperimmune plasma: a randomized trial by the Nordic Bone Marrow Transplantation Group.

https://arctichealth.org/en/permalink/ahliterature57827
Source
Bone Marrow Transplant. 1987 Oct;2(3):299-305
Publication Type
Article
Date
Oct-1987
Author
O. Ringdén
P. Pihlstedt
L. Volin
J. Nikoskelainen
B. Lönnqvist
P. Ruutu
T. Ruutu
A. Toivanen
B. Wahren
Author Affiliation
Department of Clinical Immunology, Huddinge Hospital, Sweden.
Source
Bone Marrow Transplant. 1987 Oct;2(3):299-305
Date
Oct-1987
Language
English
Publication Type
Article
Keywords
Antibodies, Viral - administration & dosage
Bone Marrow Transplantation
Cytomegalovirus Infections - diagnosis - prevention & control
Humans
Immunization, Passive
Risk factors
Serologic Tests
Abstract
Bone marrow transplantation recipients who were cytomegalovirus (CMV) seropositive and/or had a CMV seropositive donor were randomized for treatment with CMV hyperimmune plasma (n = 27) or no treatment at all (n = 27). The CMV hyperimmune plasma had neutralization titers greater than 250 and enzyme-linked immunosorbent assay titers greater than 18,000. Plasma (200 mg/kg body weight) was given on four occasions (during 2 days) from day 3 to day 76 after transplantation. Patient characteristics were similar in the two groups. After transplantation, the median CMV titers increased with greater than 100% in the group receiving the CMV plasma and decreased to less than 50% in the controls (p less than 0.01). Asymptomatic CMV infections occurred in 26% of the patients in the plasma group and 33% of the controls. The frequency of patients with symptomatic CMV infections was also the same in the two groups (51% vs 33%). Three patients each in the two groups developed CMV-associated interstitial pneumonitis. Patient survival and causes of death were similar in the two groups. To conclude, no beneficial effect of CMV hyperimmune plasma was seen in patients at high risk of developing CMV infections.
PubMed ID
2844340 View in PubMed
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Increased risk of chronic graft-versus-host disease, obstructive bronchiolitis, and alopecia with busulfan versus total body irradiation: long-term results of a randomized trial in allogeneic marrow recipients with leukemia. Nordic Bone Marrow Transplantation Group.

https://arctichealth.org/en/permalink/ahliterature10716
Source
Blood. 1999 Apr 1;93(7):2196-201
Publication Type
Article
Date
Apr-1-1999
Author
O. Ringdén
M. Remberger
T. Ruutu
J. Nikoskelainen
L. Volin
L. Vindeløv
T. Parkkali
S. Lenhoff
B. Sallerfors
L. Mellander
P. Ljungman
N. Jacobsen
Author Affiliation
Centre for Allogeneic Stem Cell Transplantation, and the Department of Hematology, Karolinska Institute, Huddinge Hospital, Huddinge, Sweden. olle.ringden@immunlab.hs.sll.se
Source
Blood. 1999 Apr 1;93(7):2196-201
Date
Apr-1-1999
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Alopecia - epidemiology - etiology
Bone Marrow Transplantation - adverse effects
Bronchiolitis Obliterans - epidemiology - etiology
Busulfan - administration & dosage - adverse effects
Cataract - epidemiology - etiology
Cause of Death
Child
Child, Preschool
Chronic Disease
Cystitis - epidemiology - etiology
Disease-Free Survival
Female
Follow-Up Studies
Graft vs Host Disease - epidemiology - etiology
Hepatic Veno-Occlusive Disease - epidemiology - etiology
Histocompatibility
Humans
Incidence
Infant
Leukemia - therapy
Lung Diseases, Interstitial - etiology - mortality
Male
Middle Aged
Multiple Organ Failure - etiology - mortality
Radiation Injuries - epidemiology - etiology
Recurrence
Research Support, Non-U.S. Gov't
Risk
Survival Analysis
Transplantation Conditioning - adverse effects - methods
Transplantation, Homologous
Treatment Outcome
Whole-Body Irradiation
Abstract
Leukemic patients receiving marrow from HLA-identical sibling donors were randomized to treatment with either busulfan 16 mg/kg (n = 88) or total body irradiation ([TBI] n = 79) in addition to cyclophosphamide 120 mg/kg. The patients were observed for a period of 5 to 9 years. Busulfan-treated patients had an increased risk of veno-occlusive disease (VOD) of the liver (12% v 1%, P =.01) and hemorrhagic cystitis (32% v 10%, P =.003). Acute graft-versus-host disease (GVHD) was similar in the two groups, but the 7-year cumulative incidence of chronic GVHD was 59% in the busulfan-treated group versus 47% in the TBI group (P =.05). Death from GVHD was more common in the busulfan group (22% v 3%, P
Notes
Comment In: Blood. 1999 Dec 1;94(11):3960-210627126
PubMed ID
10090927 View in PubMed
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Low incidence of severe acute and chronic graft-versus-host disease as a result of prolonged cyclosporine prophylaxis and early aggressive treatment with corticosteroids.

https://arctichealth.org/en/permalink/ahliterature232988
Source
Transplant Proc. 1988 Jun;20(3):491-3
Publication Type
Article
Date
Jun-1988

No prevention of cytomegalovirus infection by anti-cytomegalovirus hyperimmune globulin in seronegative bone marrow transplant recipients. The Nordic BMT Group.

https://arctichealth.org/en/permalink/ahliterature34393
Source
Bone Marrow Transplant. 1997 Feb;19(3):233-6
Publication Type
Article
Date
Feb-1997
Author
T. Ruutu
P. Ljungman
L. Brinch
S. Lenhoff
B. Lönnqvist
O. Ringdén
P. Ruutu
L. Volin
D. Albrechtsen
B. Sallerfors
F. Ebeling
G. Myllylä
Author Affiliation
Department of Medicine, Helsinki University Central Hospital, Finland.
Source
Bone Marrow Transplant. 1997 Feb;19(3):233-6
Date
Feb-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antibodies, Viral - administration & dosage
Bone Marrow Transplantation - adverse effects
Child
Child, Preschool
Cytomegalovirus - immunology - isolation & purification
Cytomegalovirus Infections - prevention & control
Female
Humans
Immunoglobulins, Intravenous - administration & dosage
Male
Middle Aged
Research Support, Non-U.S. Gov't
Tissue Donors
Abstract
A randomized multicentre study was conducted to evaluate the effect of anti-CMV hyperimmune globulin in the prophylaxis of CMV infections in CMV seronegative allogeneic BMT patients who received a transplant from a seropositive donor or who had received blood products unscreened for CMV during the treatment before BMT. Twenty-eight patients were included in the study. Thirteen were randomized to receive and 15 not to receive intravenous CMV hyperimmune globulin. A dose of 0.4 g/kg of immunoglobulin was given on day -8 and 0.2 g/kg on days -1, +7, +14, +21, +28, +35, +42, +56 and +70 in relation to the day of transplantation. Among the 15 patients not given immunoglobulin CMV was isolated in three, and two of them developed clinical CMV disease. In addition, one more patient developed CMV antibodies without virus isolation. In five of the 13 patients given immunoglobulin the virus could be isolated, and four of them developed CMV disease. One additional patient showed seroconversion but no other findings of CMV infection. The incidence of acute and chronic GVHD was similar in the two arms. There was no significant difference in survival. In conclusion, the present results do not indicate a beneficial effect of CMV hyperimmune globulin infusions in the prophylaxis of CMV infection or disease in seronegative allogeneic bone marrow transplant recipients from a seropositive donor.
PubMed ID
9028551 View in PubMed
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A Nordic registry for volunteer marrow donors?

https://arctichealth.org/en/permalink/ahliterature229368
Source
Bone Marrow Transplant. 1990 Apr;5(4):273-7
Publication Type
Article
Date
Apr-1990
Author
T. Ruutu
J M Goldman
Author Affiliation
Third Department of Medicine, University of Helsinki, Finland.
Source
Bone Marrow Transplant. 1990 Apr;5(4):273-7
Date
Apr-1990
Language
English
Publication Type
Article
Keywords
Bone Marrow Transplantation
Finland
Humans
Norway
Registries - standards
Sweden
Tissue Donors - supply & distribution
Abstract
A meeting took place in Helsinki in November 1989 to consider the scientific, clinical and financial implications of establishing a registry of volunteer bone marrow transplant donors in the Nordic countries. The possible contributions of new techniques for defining HLA genes and gene products, notably the study of restriction fragment length polymorphisms and allele specific oligonucleotides, and for selecting optimal donors, notably the assay of cytotoxic T lymphocyte precursors in the graft-versus-host direction, were discussed. The differing approaches actually used to establish new donor registries in the United Kingdom, United States and France were contrasted. The clinical results of using unrelated donors for transplanting patients with chronic myeloid leukaemia, severe aplastic anaemia and other haematological diseases were presented. Finally, participants heard details of the International Marrow Unrelated Search and Transplant Study which collects and analyses data internationally on patients for whom searches are initiated and on patients who actually receive transplants from volunteer donors.
PubMed ID
2186837 View in PubMed
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A randomized trial comparing busulfan with total body irradiation as conditioning in allogeneic marrow transplant recipients with leukemia: a report from the Nordic Bone Marrow Transplantation Group.

https://arctichealth.org/en/permalink/ahliterature11562
Source
Blood. 1994 May 1;83(9):2723-30
Publication Type
Article
Date
May-1-1994
Author
O. Ringdén
T. Ruutu
M. Remberger
J. Nikoskelainen
L. Volin
L. Vindeløv
T. Parkkali
S. Lenhoff
B. Sallerfors
P. Ljungman
Author Affiliation
Division of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Sweden.
Source
Blood. 1994 May 1;83(9):2723-30
Date
May-1-1994
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Bone Marrow Transplantation - adverse effects - mortality
Busulfan - adverse effects - therapeutic use
Cause of Death
Child
Child, Preschool
Comparative Study
Cystitis - epidemiology
Cytomegalovirus Infections - epidemiology
Graft vs Host Disease - epidemiology
Hepatic Veno-Occlusive Disease - epidemiology
Humans
Leukemia - therapy
Middle Aged
Recurrence
Research Support, Non-U.S. Gov't
Whole-Body Irradiation - adverse effects
Abstract
Between October 1988 and December 1992, 167 patients with leukemia receiving marrow transplants from HLA-identical donors and conditioned with cyclophosphamide (120 mg/kg) were randomized to additional treatment with either busulfan (16 mg/kg, n = 88) or total body irradiation (TBI; n = 79). The busulfan-treated patients had an increased cumulative incidence of veno-occlusive disease of the liver, ie, 12% compared with 1% in the TBI group (P = .009). Furthermore, hemorrhagic cystitis occurred in 24% of the busulfan patients versus 8% in the TBI patients (P = .003). In patients with advanced disease beyond first remission or first chronic phase, transplantation-related mortality was 62% among the busulfan-treated patients compared with 12% among the TBI recipients (P = .002). These differences between the two groups were statistically significant in multivariate analysis. Seizures were seen in 6% of the busulfan-treated patients and were absent in the TBI group (P = .03). Grade II-IV of acute graft-versus-host disease (GVHD) was similar in the two groups, but grade III-IV and chronic disease was more common in the busulfan-treated group (P = .04). Death associated with GVHD occurred in 17% of the busulfan-treated group and 2% of the TBI group (P = .003). Patients treated with busulfan had a 3-year actuarial survival of 62%, which was worse than the 76% among those treated with TBI (P
PubMed ID
8167351 View in PubMed
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7 records – page 1 of 1.