51
|
Kapoor N, Crooks G, Kohn DB, Parkman R. Hematopoietic stem cell transplantation for primary lymphoid immunodeficiencies. Semin Hematol 1998; 35:346-53. [PMID: 9801263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Hematopoietic stem cell (HSC) transplantation is curative therapy for many primary immunodeficiencies. All forms of severe combined immune deficiency (SCID) can be cured, but the extent of the immunologic correction is dependent on the pathophysiology of the primary defect. Defects involving lymphocyte differentiation are more easily corrected than defects in lymphocyte function because a selective advantage exists for the progeny of the normal donor HSC when the primary defect affects lymphocyte differentiation. T-cell-depleted (TCD), haploidentical-HSC transplantation can cure many forms of SCID, but not other primary immunodeficiencies like the Wiskott-Aldrich syndrome (WAS). Unrelated bone marrow and umbilical cord blood are alternative sources of HSC for patients who do not have histocompatible donors.
Collapse
|
52
|
Smith EP, Sniecinski I, Dagis AC, Parker PM, Snyder DS, Stein AS, Nademanee A, O'Donnell MR, Molina A, Schmidt GM, Stepan DE, Kapoor N, Niland JC, Forman SJ. Extracorporeal photochemotherapy for treatment of drug-resistant graft-vs.-host disease. Biol Blood Marrow Transplant 1998; 4:27-37. [PMID: 9701389 DOI: 10.1016/s1083-8791(98)90007-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Extracorporeal photochemotherapy (EP) is a therapeutic approach to the treatment of drug-resistant graft-vs.-host disease (GVHD) that uses the known immunosuppressive and immunomodulatory effects of ultraviolet light. In 1990, we initiated a pilot study to evaluate the efficacy and safety of EP in patients with refractory GVHD. Between 1991 and 1996, six patients with acute grade IV liver GVHD, 12 patients with chronic following acute GVHD, and six patients with de novo chronic GVHD were treated with EP. All patients had failed to respond to conventional GVHD immunosuppressive drug therapy of cyclosporine and prednisone. The six patients with acute liver GVHD had also received antithymocyte globulin (ATG); therapy for chronic GVHD included thalidomide in eight patients, psoralen plus ultraviolet A in five patients, and ATG in two patients. All patients with acute liver GVHD had progressive liver failure with short survival despite frequent EP. The response rate with EP treatment was 3 of 6 for patients with de novo chronic GVHD and 3 of 12 for patients with chronic following acute GVHD. Three patients with bronchiolitis obliterans had either no response or no documented disease progression while undergoing EP. Side effects of EP were minor and included gastrointestinal upset frequently, catheter-related sepsis in four patients, increased red blood cell and platelet transfusion requirements in one patient, and leukopenia in two patients. EP was discontinued in three patients because of side effects, including GI upset in one patient and bone marrow suppression in two patients. Side effects were reversible with the discontinuation of EP. We were unable to correlate response to EP with the level of methoxypsoralen, number of lymphocytes treated, or pattern of pre- and posttreatment CD4/CD8 ratio. We concluded that EP has some efficacy in the treatment of drug-resistant chronic GVHD, with minor overall toxicity.
Collapse
|
53
|
Kohn DB, Hershfield MS, Carbonaro D, Shigeoka A, Brooks J, Smogorzewska EM, Barsky LW, Chan R, Burotto F, Annett G, Nolta JA, Crooks G, Kapoor N, Elder M, Wara D, Bowen T, Madsen E, Snyder FF, Bastian J, Muul L, Blaese RM, Weinberg K, Parkman R. T lymphocytes with a normal ADA gene accumulate after transplantation of transduced autologous umbilical cord blood CD34+ cells in ADA-deficient SCID neonates. Nat Med 1998; 4:775-80. [PMID: 9662367 PMCID: PMC3777239 DOI: 10.1038/nm0798-775] [Citation(s) in RCA: 272] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Adenosine deaminase-deficient severe combined immunodeficiency was the first disease investigated for gene therapy because of a postulated production or survival advantage for gene-corrected T lymphocytes, which may overcome inefficient gene transfer. Four years after three newborns with this disease were given infusions of transduced autologous umbilical cord blood CD34+ cells, the frequency of gene-containing T lymphocytes has risen to 1-10%, whereas the frequencies of other hematopoietic and lymphoid cells containing the gene remain at 0.01-0.1%. Cessation of polyethylene glycol-conjugated adenosine deaminase enzyme replacement in one subject led to a decline in immune function, despite the persistence of gene-containing T lymphocytes. Thus, despite the long-term engraftment of transduced stem cells and selective accumulation of gene-containing T lymphocytes, improved gene transfer and expression will be needed to attain a therapeutic effect.
Collapse
|
54
|
O'Reilly R, Cheung NK, Bowman L, Castle V, Hoffer F, Kapoor N, Kletzel M, Lindsley K, Shamberger R, Tubergen D. NCCN pediatric neuroblastoma practice guidelines. The National Comprehensive Cancer Network. ONCOLOGY (WILLISTON PARK, N.Y.) 1996; 10:1813-22. [PMID: 8985966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
55
|
Chaudhary SK, Kapoor N, Jugtawat J, Chaudhary K. An improved simple method of detection of Bence Jones proteinuria. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 1996; 44:842, 845. [PMID: 9251473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
56
|
Chaudhary SK, Kapoor N, Jagtawat J. Tuberculosis of the vulva. JOURNAL OF THE INDIAN MEDICAL ASSOCIATION 1996; 94:357. [PMID: 9019088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
57
|
Mohanti BK, Rath GK, Anantha N, Kannan V, Das BS, Chandramouli BA, Banerjee AK, Das S, Jena A, Ravichandran R, Sahi UP, Kumar R, Kapoor N, Kalia VK, Dwarakanath BS, Jain V. Improving cancer radiotherapy with 2-deoxy-D-glucose: phase I/II clinical trials on human cerebral gliomas. Int J Radiat Oncol Biol Phys 1996; 35:103-11. [PMID: 8641905 DOI: 10.1016/s0360-3016(96)85017-6] [Citation(s) in RCA: 200] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Evaluation of tolerance, toxicity, and feasibility of combining large fraction (5 Gy) radiotherapy with 2-deoxy-D-glucose (2DG), an inhibitor of glucose transport and glycolysis, which has been shown to differentially inhibit repair of radiation damage in cancer cells. METHODS AND MATERIALS Twenty patients with supratentorial glioma (Grade 3/4), following surgery were treated with four weekly fractions of oral 2DG (200 mg/kg body weight) followed by whole brain irradiation (5 Gy). Two weeks later, supplement focal radiation to the tumor (14 Gy/7 fractions) was given. Routine clinical evaluation, x-ray computerized tomography (CT), and magnetic resonance (MR) imaging were carried out to study the acute and late radiation effects. RESULTS All the 20 patients completed the treatment without any interruption. The vital parameters were within normal limits during the treatment. None reported headache during the treatment. Mild to moderate nausea and vomiting were observed during the days of combined therapy (2DG + RT) in 10 patients. No significant deterioration of the neurological status was observed during the treatment period. Seven patients were alive at 63, 43, 36, 28, 27, 19, and 18 months of follow-up. In these patients, the clinical and MR imaging studies did not reveal any late radiation effects. CONCLUSIONS Feasibility of administering the treatment (2DG + 5 Gy) is demonstrated by the excellent tolerance observed in all 20 patients. Further, the clinical and MR studies also show the absence of any brain parenchymal damage.
Collapse
|
58
|
Keever CA, Leong N, Cunningham I, Copelan EA, Avalos BR, Klein J, Kapoor N, Adams PW, Orosz CG, Tutschka PJ. HLA-B44-directed cytotoxic T cells associated with acute graft-versus-host disease following unrelated bone marrow transplantation. Bone Marrow Transplant 1994; 14:137-45. [PMID: 7951101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We describe the recipient of a marrow graft from an HLA-serologically identical unrelated donor from whom highly potent host-reactive CTL of donor origin were isolated in association with acute GVHD. Extensive sequence and biochemical analysis of the HLA complex of this donor and recipient revealed several disparities in class I and class II HLA with the potential to be recognized by T cells from the donor or the host. The donor-derived CTL exclusively recognized a class I HLA difference associated with HLA-B44. Nucleotide sequencing of donor and recipient cells revealed that the patient possessed the HLA-B*4402 allele recognized by IEF as B44.2 while the donor possessed HLA-B*4403 (IEF variant B44.1). These alleles differ at one amino acid residue located at position 156 in the alpha 2 domain. The donor-derived CTL were shown to be specific for B44.2 by blocking studies and by the lysis of five different B44.2+ unrelated cell lines, two of which were confirmed by sequencing to be homozygous for B*4402. A host-specific difference involving a HLA-DRB1 allele was not recognized by the CTL, neither did HLA differences unique to the donor HLA-B*4403 and HLA-DQ8 elicit a host response. These data show that certain HLA disparities may be tolerated at the same time that other disparities elicit a potent immunologic response. The chemical nature of the difference, its structural impact, as well as the conditions of transplant appear to influence the type of response which occurs.
Collapse
|
59
|
Copelan EA, Bechtel TP, Klein JP, Klein JL, Tutschka P, Kapoor N, Featheringham NC, Avalos BR. Controlled trial of orally administered immunoglobulin following bone marrow transplantation. Bone Marrow Transplant 1994; 13:87-91. [PMID: 7517256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Between May 1987 and September 1989, 72 patients undergoing marrow transplantation at a single institution were randomized to receive 50 mg/kg of a commercial gammaglobulin preparation or placebo daily in four divided doses for 28 days following transplantation. Patients receiving oral gammaglobulin had significantly increased concentrations of stool IgG (p = 0.01) compared with the placebo group. There was no difference in the amount of diarrhea, frequency of GVHD, duration of hospitalization or survival in the two groups. The present study demonstrates that orally administered IgG can survive passage through the gastrointestinal tract of bone marrow transplantation recipients but there was no effect of oral administration of immunoglobulin on morbidity or mortality following bone marrow transplantation.
Collapse
|
60
|
Avalos BR, Klein JL, Kapoor N, Copelan EA. Allogeneic bone marrow transplantation following busulfan and 90 mg/kg of cyclophosphamide. Bone Marrow Transplant 1993; 12:655-8. [PMID: 8136749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Ten patients with AML or CML aged 40-55 years underwent allogeneic marrow transplantation from HLA-identical siblings following a preparation regimen of busulfan 16 mg/kg and cyclophosphamide (CY) 90 mg/kg. The CY dose was substantially lower than has been previously used in combination with busulfan. All 10 individuals engrafted. Cytogenetic analysis of marrow and peripheral blood cells demonstrated similar patterns of chimerism to those previously described using higher CY doses. This study demonstrates that when administered with busulfan 16 mg/kg a dose of 90 mg/kg CY is adequately immunosuppressive to permit consistent engraftment of marrow from HLA-identical sibling donors.
Collapse
MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Bone Marrow Transplantation/adverse effects
- Bone Marrow Transplantation/methods
- Busulfan/administration & dosage
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Cytogenetics
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/surgery
- Male
- Middle Aged
- Philadelphia Chromosome
- Transplantation, Homologous
Collapse
|
61
|
Yuan R, Yager D, Guethlein M, Oliver G, Kapoor N, Zhong R. Controlling unwanted sources of threshold change in disability glare studies: a prototype apparatus and procedure. Optom Vis Sci 1993; 70:976-81. [PMID: 8302535 DOI: 10.1097/00006324-199311000-00016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
One of the main purposes of cataract surgery is to reduce the debilitating effects of light scatter by the lens. An important effect of this intraocular forward scatter is to produce a veiling retinal illuminance from a glare source. The retinal contrast of the stimulus is thus reduced, and a quantifiable "disability glare" effect may be measured. A complication is introduced by the fact that intraocular scatter arises from other sources in addition to the lens. All present tests of glare disability fail to eliminate or control for these factors, nor do they control for the light adaptation effect of the glare source. The effects of lens removal may not be predicted accurately by such tests, and patients may report little improvement in visual function after surgery. The goal of this research is to provide the background for developing a method of measuring disability glare due only to light scatter in the lens. Thirty-seven patients with mild to moderate cortical cataracts served as subjects. A disability glare effect (DG) was measured with a Maxwellian-view system that eliminates or controls scatter from the iris, sclera, and retina, and which controls for light-adaptation effects from the glare source. DG with this method showed a significant correlation with objective measures of lens light back scatter. Suggestions were made for improvements in the apparatus and procedures for future clinical studies.
Collapse
|
62
|
Olson TA, Kapoor N, Wing C, Tutschka P. Megakaryocyte colony stimulating activity in allogenic bone marrow recipients prepared with busulfan and cyclophosphamide. Br J Haematol 1993; 85:365-70. [PMID: 8280609 DOI: 10.1111/j.1365-2141.1993.tb03180.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Increased megakaryocyte colony stimulating activity (MK-CSA) has been reported after total body irradiation (TBI) for bone marrow transplant (BMT). We studied the effect of a busulfan (Bu) and cyclophosphamide (Cy) marrow transplant conditioning regimen, without radiation, on MK-CSA production. Initial screening of MK-CSA was done on previously collected and banked sera from 14 BMT patients. MK-CSA was expressed as the ability to stimulate growth of megakaryocyte progenitors (CFU-MK) in standard plasma clot cultures. In the initial samples, MK-CSA peaked at day 7. This preliminary data led to a prospective study of MK-CSA and clinical parameters in seven allogeneic recipients. MK-CSA activity increased from day -7 pre-transplant (2.9 +/- 1.7 CFU-MK/10(5) NATD, mean +/- SD) to day 0 (10.3 +/- 4.7 CFU-MK) and peaked by day 9 post-transplant (20.6 +/- 6.4 CFU-MK). MK-CSA activity decreased in all seven patients by day 21 at which time five of seven patients studied had recovery of platelet counts to greater than 100 x 10(9)/l. MK-CSA activity rose rapidly in both groups of sera after the initiation of this non-irradiation, BMT preparative regimen. High MK-CSA levels, early after transplant, may contribute to the rapid platelet recovery in some patients.
Collapse
|
63
|
Ezzone S, Jolly D, Replogle K, Kapoor N, Tutschka PJ. Survey of oral hygiene regimens among bone marrow transplant centers. Oncol Nurs Forum 1993; 20:1375-81. [PMID: 8265442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Oral complications may occur as an adverse effect of the preparative regimens used in bone marrow transplantation (BMT). A variety of oral-care regimens are used to manage the prevention and treatment of oral complications. The purpose of this descriptive survey was to identify similarities and differences in oral-care regimens among various BMT centers. A 35-item questionnaire was sent to 92 BMT centers, with an 80% response rate. The responses were analyzed using descriptive statistics. Following a variety of guidelines, routine oral assessments were performed by physicians (41%), nurses (33%), and dentists (25%). Thirty-eight percent of the BMT centers used WBC counts as a basis for changing the oral hygiene regimen; 90% used platelet counts. When toothbrushing was discontinued, 50% of the centers used toothettes. In 54% of the centers, flossing was not used in oral hygiene regimens. The two primary mouth-rinses used were chlorhexidine and normal saline. In summary, few similarities existed in the assessment and management of oral care.
Collapse
|
64
|
Keever CA, Klein J, Leong N, Copelan EA, Avalos BR, Kapoor N, Cunningham I, Tutschka PJ. Effect of GVHD on the recovery of NK cell activity and LAK precursors following BMT. Bone Marrow Transplant 1993; 12:289-95. [PMID: 8241989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The mechanism by which GVHD augments the graft-versus-leukemia (GVL) effect of marrow transplants has not been ascertained. One possibility involves the secondary activation of natural killer (NK) cells by cytokines released during the GVHD process. To evaluate this possibility we have compared NK activity and lymphokine-activated killer cell precursor (LAKp) frequencies in serially sampled PBMC from recipients of unmanipulated autologous or allogeneic marrow with and without active GVHD. NK activity recovered rapidly after BMT and was elevated during episodes of acute GVHD. However, NK activity did not differ between recipients of autologous or allogeneic marrow without GVHD nor was NK activity increased in association with chronic GVHD. Endogenously-activated NK cells were detected only in recipients of allogeneic marrow but this did not correlate with GVHD status. In contrast to NK activity, LAKp frequencies fell below the control range during the first 8 weeks after BMT. By 9-14 weeks the median LAKp frequency was normal and did not differ between the three groups then or later after transplant. We conclude that acute GVHD may serve to increase the lytic activity of NK cells but does not result in increased LAKp. LAKp frequencies are below normal during the first two months after BMT, a finding not previously recognized from bulk culture LAK studies. The role of LAK effectors in GVL may involve more the degree of cellular activation rather than the number of cells activated.
Collapse
|
65
|
Abstract
The Glasgow Coma Scale permits 120 possible mathematical combinations of eye, verbal and motor scores. Out of these only about 15 are clinically valid and useful in the assessment of altered consciousness. A mathematical analysis of this pruned scale shows a predominant skew towards the motor response. Without clinically altering the scale. The numerical values can be modified to produce a more equitable dominance by each of the factors and greater precision. This is also necessary as the value of a unit is the same in the sum score, whether contributed by the eye, verbal or motor elements.
Collapse
|
66
|
Copelan EA, Biggs JC, Szer J, Thompson JM, Crilley P, Brodsky I, Klein JL, Kapoor N, Harman GS, Avalos BR. Allogeneic bone marrow transplantation for acute myelogenous leukemia, acute lymphocytic leukemia, and multiple myeloma following preparation with busulfan and cyclophosphamide (BuCy2). Semin Oncol 1993; 20:33-8; quiz 39. [PMID: 8342074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The combination of busulfan (Bu) and cyclophosphamide (Cy) has been found to be effective preparative therapy for patients treated with allogeneic bone marrow transplantation (BMT). We developed the BuCy2 regimen, which contains a lower dose of cyclophosphamide than the original BuCy regimen, in the hope of reducing regimen-related toxicities. We have studied the use of BuCy2 as preparation for allogeneic BMT in patients with acute myelogenous leukemia, acute lymphocytic leukemia, and multiple myeloma. In patients with acute myelogenous leukemia, the leukemia-free survival and regimen-related toxicity rates obtained in our study appear similar to those achieved with other preparative regimens, including those containing Cy and total body irradiation (TBI). BuCy2 is also an effective BMT preparative regimen in patients with acute lymphocytic leukemia and multiple myeloma. Treatment with BuCy2 results in a lower incidence of severe stomatitis and probably of interstitial pneumonia than does treatment with Cy/TBI, but hepatic veno-occlusive disease occurs more frequently in BuCy-treated patients. The incidence of veno-occlusive disease appears to be affected by agents used as prophylaxis for graft-versus-host disease. Compared with Cy/TBI regimens, BuCy treatment is likely to result in fewer delayed effects of treatment, such as impairment of fertility and second malignancies. Current clinical efforts are focusing on ways to improve the antileukemic activity of the BuCy preparative regimen and to reduce regimen-related toxicities.
Collapse
|
67
|
Avalos BR, Klein JL, Kapoor N, Tutschka PJ, Klein JP, Copelan EA. Preparation for marrow transplantation in Hodgkin's and non-Hodgkin's lymphoma using Bu/CY. Bone Marrow Transplant 1993; 12:133-8. [PMID: 8401359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The results of autologous and allogeneic BMT in 44 patients with Hodgkin's or non-Hodgkin's lymphomas who received preparative therapy consisting of busulfan 16 mg/kg and cyclophosphamide 120 mg/kg are presented. Sixteen patients are surviving free of disease between 8 months and 6 years after transplantation. Thirteen patients either did not attain complete remission or experienced a recurrence of their disease. Fifteen patients died from treatment-related complications. Karnofsky score < or = 70, lactate dehydrogenase greater than twice normal and the development of hepatic veno-occlusive disease were associated with failure to achieve lymphoma-free survival.
Collapse
|
68
|
Allen CM, Kapoor N. Verruciform xanthoma in a bone marrow transplant recipient. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:591-4. [PMID: 8488027 DOI: 10.1016/0030-4220(93)90231-r] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The verruciform xanthoma is an uncommon benign condition of uncertain cause that affects either mucosa or, less commonly, skin. Most lesions are solitary, and most have been reported to involve the oral mucosa. In some instances, chronic damage to the lesional site has been identified. This report describes a verruciform xanthoma that developed on the lower vermillion zone of the lip of a young person who had undergone allogeneic bone marrow transplantation for acute lymphoblastic leukemia. To our knowledge, this is the first reported case of this lesion occurring in a bone marrow transplantation patient. We speculate that immunologically mediated damage to the patient's epithelium in this area may be related to the pathogenesis of the lesion.
Collapse
|
69
|
Rosenfield M, D'Amico JL, Nowbotsing S, Kapoor N, Ciuffreda KJ. Temporal characteristics of proximally-induced accommodation. Ophthalmic Physiol Opt 1993; 13:151-4. [PMID: 8265149 DOI: 10.1111/j.1475-1313.1993.tb00444.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study sought to determine whether proximally-induced accommodation (PIA) is capable of sustaining an accommodative response over time. Accordingly, the steady-state PIA response was measured during the course of a continuous 5 min stimulus period for targets located at distances of 0.2 or 6 m. The vergence and accommodation loops were opened by subjects (n = 8) monocularly viewing the targets through a 0.5 mm pinhole, while accommodation was assessed using an objective, open-field, infrared optometer. The mean PIA response did not change significantly during the fixation period. This finding suggests that PIA is indeed capable of maintaining a sustained response. This observation is consistent with the constancy of apparent target distance perception during extended fixation of a stationary object of regard under these conditions.
Collapse
|
70
|
Biggs JC, Szer J, Crilley P, Atkinson K, Downs K, Dodds A, Concannon AJ, Avalos B, Tutschka P, Kapoor N. Treatment of chronic myeloid leukemia with allogeneic bone marrow transplantation after preparation with BuCy2. Blood 1992; 80:1352-7. [PMID: 1515648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
One hundred fifteen patients with chronic myelocytic leukemia (CML) were administered busulphan 4 mg/kg for 4 days and cyclophosphamide 60 mg/kg on each of 2 days (BuCy2) followed by allogeneic bone marrow transplantation from histocompatible sibling donors. For 62 patients in chronic phase, 26 in accelerated phase, and 27 in blast transformation, the actuarial survival at 3 years was 58%, 41%, and 25%, respectively. Actuarial probability of relapse was 3%, 12%, and 27%, respectively. Only two patients in chronic phase showed a transient cytogenetic relapse and one of these died from subsequent transplant-related complications, whereas the other remains cytogenetically normal 697 days posttransplant. Patients who were transplanted within 1 year of diagnosis in chronic phase had a survival of 70% compared with 40% when transplanted beyond 1 year from diagnosis. This significant difference in survival was due to transplant-related complications and was correlated with previous exposure to high doses of busulphan. This study indicates that BuCy2 is a useful conditioning regimen for marrow transplantation in patients with CML and results in similar survival statistics and transplant-related mortality as would be expected with conditioning regimens containing total body irradiation. It is possible that relapse after BuCy2 may be lower than expected with regimens containing total body irradiation, but larger analyses are required.
Collapse
|
71
|
Copelan EA, Avalos BR, Kapoor N, Bechtel T, Tutschka PJ. Alternate applications of immunoglobulin following bone marrow transplantation. Semin Hematol 1992; 29:96-9. [PMID: 1324531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
72
|
Kapoor N, Pelligrini AE, Copelan EA, Cunningham I, Avalos BR, Klein JL, Tutschka PJ. Psoralen plus ultraviolet A (PUVA) in the treatment of chronic graft versus host disease: preliminary experience in standard treatment resistant patients. Semin Hematol 1992; 29:108-12. [PMID: 1594942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
73
|
Copelan EA, Biggs JC, Avalos BR, Szer J, Cunningham I, Klein JP, Atkinson K, Kapoor N, Klein JL, Downs K. Radiation-free preparation for allogeneic bone marrow transplantation in adults with acute lymphoblastic leukemia. J Clin Oncol 1992; 10:237-42. [PMID: 1732424 DOI: 10.1200/jco.1992.10.2.237] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The study was undertaken to investigate the effectiveness of allogeneic bone marrow transplantation from HLA-identical siblings after preparation with busulfan and cyclophosphamide in adults with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS Thirty-nine patients aged 15 to 42 years underwent transplantation at three different centers from November 1984 through November 1990. All patients received 16 mg/kg busulfan and 120 mg/kg cyclophosphamide as preparative therapy. Cyclosporine plus methotrexate or cyclosporine plus corticosteroids with or without methotrexate were given for prevention of graft-versus-host disease (GVHD). RESULTS Twelve patients died of treatment-related complications, 12 patients relapsed, and 15 patients are leukemia-free survivors. For 27 patients in group 1 (first remission, second remission, first relapse), the estimated leukemia-free survival (LFS) rate is 42.3% (95% confidence interval [CI], 22.9% to 71.7%) at 3 years. For 12 patients with more advanced disease (group 2), the 1-year LFS rate is 13.5% (95% CI, 0% to 37.1%). Chronic GVHD occurred at an estimated incidence of 63.3% and developed significantly more frequently among patients who received corticosteroids for prevention of acute GVHD. Chronic GVHD was associated with a significantly lower incidence of relapse and with improved LFS rates. CONCLUSION LFS rate in this study is comparable to that obtained with radiation-containing regimens; however, the effectiveness of this preparative regimen in ALL requires further study.
Collapse
|
74
|
Kapoor N, Keever CA, Hsu SH, Copelan EA, Tutschka PJ. Prolonged remission of accelerated phase Philadelphia chromosome negative chronic myeloid leukemia following autologous recovery of normal hematopoietic elements after busulfan/cyclophosphamide and allogeneic marrow transplantation. Bone Marrow Transplant 1992; 9:143-5. [PMID: 1349249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
We describe here a patient with accelerated phase Philadelphia chromosome (Ph1) negative chronic myelogenous leukemia without BCR gene rearrangement, who received an allogeneic bone marrow transplant following a conditioning regimen consisting of busulfan (BU) and cyclophosphamide (CY). Hematopoiesis was restored following splenectomy performed 1 month post-transplant. There were no distinguishing cytogenetic differences between donor and host. Five years post-transplant the patient relapsed with the original disease. Restriction fragment length polymorphism (RFLP) studies performed at that time exhibited host specific DNA markers suggesting recurrent leukemia of host origin. RFLP analysis of the cells cryopreserved immediately post-transplant also revealed all cells to be of host origin. This patient experienced 5 years of remission with autologous hematopoietic recovery from an aggressive myeloproliferative disorder after high dose BU and CY without engraftment of donor hematopoietic cells.
Collapse
MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow Purging
- Bone Marrow Transplantation
- Busulfan/administration & dosage
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Genetic Markers
- Graft Survival
- Humans
- Hydroxyurea/administration & dosage
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Leukemia, Myeloid, Accelerated Phase/surgery
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/drug therapy
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/surgery
- Male
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Polymorphism, Restriction Fragment Length
- Remission Induction
- Splenectomy
- Transplantation, Homologous
Collapse
|
75
|
Keever C, Leong N, Cunningham I, Copelan E, Avalos B, Klein J, Kapoor N, Tutschka P. Hla-b44.2 directed cytotoxic t cells associated with acute graft vs host disease following unrelated marrow transplantation. Hum Immunol 1991. [DOI: 10.1016/0198-8859(91)90255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
76
|
Ghany AM, Tutschka PJ, McGhee RB, Avalos BR, Cunningham I, Kapoor N, Copelan EA. Cyclosporine-associated seizures in bone marrow transplant recipients given busulfan and cyclophosphamide preparative therapy. Transplantation 1991; 52:310-5. [PMID: 1871805 DOI: 10.1097/00007890-199108000-00024] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Five of 182 recipients of allogeneic bone marrow transplants performed between 2/84 and 6/90 developed seizures while receiving cyclosporine and methylprednisolone to prevent acute graft-versus-host disease. All received a radiation-free regimen of busulfan and cyclophosphamide as preparative therapy. Two patients received HLA-mismatched allografts; and three patients received marrow from HLA-identical sibling donors. Two patients had received extensive intrathecal therapy prior to transplantation. All patients were receiving standard prophylactic doses of CsA and MP at the time of onset (median 31 days posttransplantation) of seizures. Three patients had mild-to-moderate hypertension and varying degrees of morphologic evidence of microangiopathic hemolytic anemia. None had unusually low magnesium levels. Cyclosporine levels were not in the toxic range. Cranial magnetic resonance imaging and computed tomography (CT) showed bilateral abnormalities primarily in the posterior temporal, occipital, and parietal lobes. These abnormalities were shown to be transient on sequential MRI exams in two patients. Seizures as well as radiologic abnormalities resolved on stopping CsA and did not recur in 2 patients who subsequently received CsA in lower doses. These findings confirm and expand previous observations of CsA-associated seizures and demonstrate that they occur in allogeneic bone marrow transplant recipients following a radiation-free preparative regimen of busulfan and cyclophosphamide.
Collapse
|
77
|
Copelan EA, Biggs JC, Thompson JM, Crilley P, Szer J, Klein JP, Kapoor N, Avalos BR, Cunningham I, Atkinson K. Treatment for acute myelocytic leukemia with allogeneic bone marrow transplantation following preparation with BuCy2. Blood 1991; 78:838-43. [PMID: 1859895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
One hundred twenty-seven patients with acute myelocytic leukemia (AML) were given busulfan 4 mg/kg on each of 4 days and cyclophosphamide 60 mg/kg on each of 2 days (BuCy2) followed by allogeneic bone marrow transplantation from an HLA-identical or one antigen disparate sibling. For 71 patients in first complete remission, 23 in second complete remission or initial relapse, and 33 patients with primary refractory disease, second or subsequent relapse, or a preceding hematologic disorder, the 3-year leukemia-free survival (LFS) is 63.1%, 32.6%, and 24.2% respectively. The actuarial probability of relapse for each group is 14.1%, 40.6%, and 61.0%. In multivariate analyses, relapse and decreased LFS were associated with advanced disease phase and with M4/M5 French-American-British classification. The LFS of first remission patients was adversely associated with a short time interval from diagnosis to transplantation. This study indicates that BuCy2 is an attractive preparative regimen for marrow transplantation in patients with AML and that prognostic factors for relapse and LFS are similar those described for regimens containing total body irradiation.
Collapse
|
78
|
Tutschka PJ, Copelan EA, Kapoor N, Avalos BR, Klein JP. Allogeneic bone marrow transplantation for leukemia using chemotherapy as conditioning: 6-year results of a single institution trial. Transplant Proc 1991; 23:1709-10. [PMID: 1989335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
79
|
St John RC, Gadek JE, Tutschka PJ, Kapoor N, Dorinsky PM. Analysis of airflow obstruction by bronchoalveolar lavage following bone marrow transplantation. Implications for pathogenesis and treatment. Chest 1990; 98:600-7. [PMID: 2394138 DOI: 10.1378/chest.98.3.600] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The development of airflow obstruction, most often due to bronchiolitis, is a significant cause of morbidity and mortality in recipients of allogeneic BMT. Current consensus holds that this airways disease is the result of chronic GVHD and/or CMV infection. However, recent studies of idiopathic forms of BRO have demonstrated a striking influx of neutrophils into the lungs of affected individuals. Reasoning that the immune cell populations involved in tissue injury associated with either CGVHD or CMV infection would consist predominantly of lymphocytes, we tested this hypothesis by performing BAL in 12 adults with minimal or absent smoking histories who developed significant airflow obstruction (FEV1/FVC = 80.7 +/- 1 percent preBMT and 56.8 +/- 2.4 percent postBMT; p less than 0.001) following allogeneic BMT. Eleven of 12 patients had evidence of chronic, stable GVHD at the time of the study. In contrast to non-BMT patients with BRO, BAL defined two distinct patterns of lung inflammation in the BMT patients with airflow obstruction: (a) neutrophil predominance (five patients; neutrophil percentage = 20.2 +/- 6.6 percent); and (b) lymphocyte predominance (three patients; lymphocyte percentage = 35.9 +/- 12.1 percent). These data suggest that the pattern of inflammation in the lungs of BMT patients with BRO is not uniform and is not associated with active microbial infection. From these results, it is inferred that the airways injury in BMT patients may reflect diverse pathogenetic mechanisms initiated in the context of CGVHD and cytotoxic drug therapy.
Collapse
|
80
|
Incefy GS, Flomenberg N, Heller G, Kernan NA, Brochstein J, Kirkpatrick D, Kapoor N, Groshen S, O'Reilly RJ. Evidence that appearance of thymulin in plasma follows lymphoid chimerism and precedes development of immunity in patients with lethal combined immunodeficiency transplanted with T cell-depleted haploidentical marrow. Transplantation 1990; 50:55-61. [PMID: 2368151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thymulin, a peptide secreted by human thymic epithelial cells, circulates in peripheral blood. Levels of plasma thymulin (FTS-Zn) activity were analyzed in 21 patients with lethal combined immunodeficiency disorders who were treated with transplantation of HLA-haplotype-mismatched parental bone marrow depleted of T cells by differential agglutination with soybean agglutinin and E-rosetting (SBA-E-BMT). Among these 21 infants, 15 were patients with severe combined immunodeficiency (SCID) and 6 had combined immunodeficiency (CID) with Omenn's syndrome or CID with T cell predominance (CIDTP). In contrast to normal infants who possess high levels of plasma thymulin activity, 20 of the 21 patients demonstrated undetectable or low plasma thymulin levels for their age at admission prior to transplantation. Following SBA-E-BMT, however, thymulin became detectable in the plasma of 17 of 18 evaluable patients and reached normal or near-normal levels between 21 and 125 days posttransplant. In patients in whom the timing of engraftment could be established by emergence of donor lymphocytes, thymulin appeared in the plasma at approximately the same time as lymphoid chimerism was detected, and in all patients who were engrafted and immunologically reconstituted, the increment in thymulin levels preceded development of immune functions. These studies support the concept that normal marrow-derived cells in the graft can provide a stimulus necessary for induction of thymic epithelial secretory function in patients with thymic dysplasia. Further, immunologic reconstitution in these patients was not seen following SBA-E-BMT unless and until recovery of thymus function had been observed.
Collapse
|
81
|
Copelan EA, Kapoor N, Gibbins B, Tutschka PJ. Allogeneic marrow transplantation in non-Hodgkin's lymphoma. Bone Marrow Transplant 1990; 5:47-50. [PMID: 2404530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Nine individuals between 15 and 43 years of age with non-Hodgkin's lymphoma underwent allogeneic marrow transplantation following busulfan 16 mg/kg and cyclophosphamide 120 mg/kg. These individuals were not considered optimal candidates for autologous transplantation chiefly because of marrow involvement or resistance to chemotherapy. All patients engrafted and eight achieved complete remission. Three patients relapsed; one patient died of transplant-related complications. Five individuals are disease-free survivors between 103 and 1169 days following transplantation. Of three individuals with relapsed Burkitt's lymphoma none experienced a sustained disease-free interval following transplantation. Three of four individuals with large cell or lymphoblastic lymphoma are surviving 585 to 1169 days following transplantation. Allogeneic marrow transplantation following busulfan and cyclophosphamide appears reasonably safe and is effective in selected patients with non-Hodgkin's lymphoma who are not good candidates for autologous marrow transplantation.
Collapse
|
82
|
Kapoor N, Copelan EA, Klein J, Tutschka PJ. Graft-versus-host disease: effects on long term disease free survival in marrow transplantation for haematological malignancies. Bone Marrow Transplant 1989; 4 Suppl 4:153-5. [PMID: 2697430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
83
|
Kapoor N, Saxena M, Chhibber S. Incidence of klebocinogeny using two indicator systems. Indian J Med Res 1989; 89:384-8. [PMID: 2695458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The incidence of bacteriocinogeny among 117 clinical isolates of Klebsiella pneumoniae was examined using two systems of indicators-K. pneumoniae WC indicator and the Abbott-Shannon set of indicators. None of the isolate tested produced bacteriocin active on K. pneumoniae WC while 23 per cent positivity was observed with the Abbott-Shannon indicators. Most of the bacteriocin producers were urinary isolates (53.8%) followed by 15.3 and 30.7 per cent respectively of faecal and miscellaneous isolates. Our results indicate the advantages of using a set of indicators over a single indicator strain.
Collapse
|
84
|
Copelan EA, Kapoor N, Berliner M, Tutschka PJ. Bone marrow transplantation without total-body irradiation in patients aged 40 and older. Transplantation 1989; 48:65-8. [PMID: 2665238 DOI: 10.1097/00007890-198907000-00015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We evaluated relapse-free survival and the incidence and type of complications in 17 patients aged 40 or older with chronic myelogenous leukemia, acute myelogenous leukemia, or lymphoma who underwent allogeneic marrow transplantation following busulfan 16 mg/kg and cyclophosphamide 120 mg/kg. Nine patients are disease-free survivors 5-38 months (median 26 months) following transplantation. The incidence of grades II-IV acute graft-versus-host disease was 35%. No significant difference was detected in the incidence of GVHD or interstitial pneumonia between patients aged 40 and older and a group of younger patients transplanted over the same time period. These observations should encourage consideration of allogeneic marrow transplantation in older patients and suggest that this busulfan-cyclophosphamide regimen is a promising alternative to regimens containing total-body irradiation in older individuals.
Collapse
|
85
|
Copelan EA, Grever MR, Kapoor N, Tutschka PJ. Marrow transplantation following busulfan and cyclophosphamide for chronic myelogenous leukaemia in accelerated or blastic phase. Br J Haematol 1989; 71:487-91. [PMID: 2653406 DOI: 10.1111/j.1365-2141.1989.tb06307.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Between July 1984 and October 1987, 21 patients with chronic myelogenous leukaemia in an accelerated or blastic phase were treated with 16 mg/kg of busulfan and 120 mg/kg of cyclophosphamide followed by infusion of bone marrow from an HLA-identical sibling donor. The regimen was well tolerated. Except for one individual with severe marrow fibrosis all patients achieved a complete remission. Only one patient relapsed. Seven of 13 patients transplanted in an accelerated phase and five of eight transplanted in a blastic phase are alive without Philadelphia chromosomes between 8 and 48 months (median 29 months) following transplantation. The estimated probability of relapse-free 3-year survival is 55%. These results indicate that busulfan and cyclophosphamide combined with allogeneic marrow transplantation exert a potent anti-leukaemic effect in patients in the accelerated or blastic phase of CML.
Collapse
|
86
|
Kapoor N, Chhibber S, Vadehra DV. Susceptibility of multidrug-resistant isolates of Klebsiella pneumoniae to silver nitrate. Folia Microbiol (Praha) 1989; 34:94-8. [PMID: 2666288 DOI: 10.1007/bf02823685] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multidrug-resistant (MDR) clinical isolates of Klebsiella pneumoniae were checked for their sensitivity toward silver nitrate by the tube-dilution method. Nearly 75% of MDR strains could be successfully inhibited by 5 mg/L of silver nitrate. A significant correlation was observed between incidence of silver and trimoxazole resistance and silver and kanamycin resistance in these isolates. The genetic linkage of these two properties could not be proved since simultaneous curing and co-transfer studies gave negative results.
Collapse
|
87
|
Kapoor N, Copelan EA, Tutschka PJ. Cytomegalovirus infection in bone marrow transplant recipients: use of intravenous gamma globulin as a prophylactic and therapeutic agent. Transplant Proc 1989; 21:3095-6. [PMID: 2539686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
88
|
Tutschka PJ, Copelan EA, Kapoor N. Replacing total body irradiation with busulfan as conditioning of patients with leukemia for allogeneic marrow transplantation. Transplant Proc 1989; 21:2952-4. [PMID: 2650402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
89
|
Copelan EA, Bechtel T, Featheringham NC, Grose MM, Sedmak DD, Kapoor N, Tutschka PJ. Oral administration of IgG in marrow transplant recipients. DRUG INTELLIGENCE & CLINICAL PHARMACY 1988; 22:912. [PMID: 3069429 DOI: 10.1177/106002808802201119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
90
|
Copelan EA, Kapoor N, Murcek M, Theil K, Tutschka PJ. Marrow transplantation following busulfan and cyclophosphamide as treatment for translocation (4;11) acute leukaemia. Br J Haematol 1988; 70:127-8. [PMID: 3052567 DOI: 10.1111/j.1365-2141.1988.tb02447.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
91
|
Kapoor N, Hvizdala E, Good RA. High dose intravenous gammaglobulin as an approach to treatment of antibody mediated pancytopenia. Br J Haematol 1988; 69:98-9. [PMID: 3132967 DOI: 10.1111/j.1365-2141.1988.tb07610.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
92
|
Chhibber S, Goel A, Kapoor N, Saxena M, Vadehra DV. Bacteriocin (klebocin) typing of clinical isolates of Klebsiella pneumoniae. Eur J Epidemiol 1988; 4:115-8. [PMID: 3281855 DOI: 10.1007/bf00152702] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Three-hundred-forty-two clinical isolates of Klebsiella pneumoniae were subjected to bacteriocin (klebocin) typing using six standard klebocin-producer strains (153-158). The overall typability was 72.8 per cent. The predominant klebocin types found were 244 (14.3 per cent), 313 (13.7 per cent) and 113 (7.6 per cent). Klebocin types 314 and 111 each contributed 5.2 per cent to the total number of isolates. No significant correlation was observed between the source of isolation and the klebocin type.
Collapse
|
93
|
Kapoor N, Elhence GP, Mital HS, Pratap VK, Khanna CM. A study of right ventricular infarction. Indian Heart J 1987; 39:29-33. [PMID: 3505500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
|
94
|
O'Reilly RJ, Brochstein J, Collins N, Keever C, Kapoor N, Kirkpatrick D, Kernan N, Dupont B, Burns J, Reisner Y. Evaluation of HLA-haplotype disparate parental marrow grafts depleted of T lymphocytes by differential agglutination with a soybean lectin and E-rosette depletion for the treatment of severe combined immunodeficiency. Vox Sang 1986; 51 Suppl 2:81-6. [PMID: 3532540 DOI: 10.1111/j.1423-0410.1986.tb02013.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The factors that impact upon successful bone marrow transplantation leading to immunologic reconstitution in severe combined immune deficiency (SCID). Wiskott-Aldrich syndrome, and in other lethal congenital immunodeficiencies are reviewed. Evidence is presented that graft-versus-host disease (GVHD) can be abrogated by the depletion of T cells, even from histoincompatible marrow grafts. However, graft resistance or restricted immune reconstitution has been observed with significant frequency. The bases for T cell reconstitution and limitations in B cell humoral immune recovery in the postgrafting period are reviewed, together with emerging evidence that pretransplant cytoreduction might obviate some of these problems.
Collapse
|
95
|
Jung LK, Fu SM, Hara T, Kapoor N, Good RA. Defective expression of T cell-associated glycoprotein in severe combined immunodeficiency. J Clin Invest 1986; 77:940-6. [PMID: 3081578 PMCID: PMC423487 DOI: 10.1172/jci112393] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A T cell surface membrane-associated glycoprotein, Tp40 (40,000 mol wt), also designated as CD-7, was not expressed by the T cells of a patient with severe combined immunodeficiency. In addition to this abnormality, T cell proliferative responses to mitogens were defective and the IL-2 receptor expression was deficient on the patient's T lymphocytes. However, his T cells were found to provide help for the differentiation of normal B cells to Ig-secreting cells. Abundant circulating B cells were detected. These B cells proliferated normally in the presence of anti-mu antibodies and B cell growth factors, but did not differentiate into antibody-secreting cells when provided with the help of normal T cells. In addition, his activated B cells did not proliferate to IL-2 even though IL-2 receptors were expressed. A successful allogeneic histocompatible bone marrow transplantation resulting in T cell engraftment corrected both the T and B cell immunodeficiencies. These findings support the hypothesis that the Tp40 deficiency present in this patient is related to a defect of the T cell precursors, and that Tp40 plays important roles not only essential to T cell interactions but also to certain aspects of T-B cell interaction during the early lymphoid development.
Collapse
|
96
|
Kapoor N, Jung LK, Engelhard D, Filler J, Shalit I, Landreth KS, Good RA. Lymphoma in a patient with severe combined immunodeficiency with adenosine deaminase deficiency, following unsustained engraftment of histoincompatible T cell-depleted bone marrow. J Pediatr 1986; 108:435-8. [PMID: 3512811 DOI: 10.1016/s0022-3476(86)80892-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
97
|
Engelhard D, Waner JL, Kapoor N, Good RA. Effect of intravenous immune globulin on natural killer cell activity: possible association with autoimmune neutropenia and idiopathic thrombocytopenia. J Pediatr 1986; 108:77-81. [PMID: 3080573 DOI: 10.1016/s0022-3476(86)80772-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Natural killer cell (NK) activity was assessed in patients before and after treatment with intravenously administered immune globulin (IVIG). In eight patients with hypogammaglobulinemia or agammaglobulinemia receiving 300 mg/kg/dose IVIG every 4 weeks, NK activity was significantly lower after therapy than before. In two patients, one with idiopathic thrombocytopenic purpura and one with autoimmune neutropenia, receiving high doses (2 gm/kg) of IVIG, NK activity was unusually high before therapy. After treatment, NK activity decreased in correlation with the clinical response and elevation of peripheral cell counts. These data show that IVIG diminishes NK activity in vivo and that reduction of NK activity may be associated with clinical improvement in idiopathic thrombocytopenic purpura and autoimmune neutropenia. NK activity of lymphocytes obtained from healthy volunteers was reduced by the same concentrations of maltose or sucrose present in Gamimune or Sandoglobulin, respectively; IVIG preparations, however, were more inhibitory. The diminution of NK activity therefore may be related to two components of IVIG preparations, monomeric IgG and maltose or sucrose.
Collapse
|
98
|
Singh PI, Kapoor N, Sood AK, Maini BK. Variability in diastolic time intervals with age. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 1985; 33:509-12. [PMID: 4055676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
99
|
Landreth KS, Engelhard D, Beare MH, Kincade PW, Kapoor N, Good RA. Regulation of human B lymphopoiesis: effect of a urinary activity associated with cyclic neutropenia. THE JOURNAL OF IMMUNOLOGY 1985. [DOI: 10.4049/jimmunol.134.4.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Urine from a patient with cyclic neutropenia was found to contain a lymphopoietic activity that acts as a growth factor for human pre-B cells. This biologic activity was detectable during the week preceding, but not during, the period of neutropenia. This corresponded with a periodic excessive accumulation of pre-B cells in the marrow of this patient. Urine preparations were added to cultures of normal human bone marrow that had been depleted of B cells. Pre-B cells were generated in these cultures but not in cultures containing urine preparations from normal donors. Pre-B cells were also generated from bone marrow that had been depleted of 177.17+ cells and the majority of pre-B cells. This is the first report of a hemopoietic activity which affects human pre-B cells. This activity may represent a normal regulatory molecule that is periodically produced in excess in this patient.
Collapse
|
100
|
Landreth KS, Engelhard D, Beare MH, Kincade PW, Kapoor N, Good RA. Regulation of human B lymphopoiesis: effect of a urinary activity associated with cyclic neutropenia. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 1985; 134:2305-9. [PMID: 3871812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Urine from a patient with cyclic neutropenia was found to contain a lymphopoietic activity that acts as a growth factor for human pre-B cells. This biologic activity was detectable during the week preceding, but not during, the period of neutropenia. This corresponded with a periodic excessive accumulation of pre-B cells in the marrow of this patient. Urine preparations were added to cultures of normal human bone marrow that had been depleted of B cells. Pre-B cells were generated in these cultures but not in cultures containing urine preparations from normal donors. Pre-B cells were also generated from bone marrow that had been depleted of 177.17+ cells and the majority of pre-B cells. This is the first report of a hemopoietic activity which affects human pre-B cells. This activity may represent a normal regulatory molecule that is periodically produced in excess in this patient.
Collapse
|