melphalan and Autoimmune-Diseases

To investigate the clinical characteristics and histopathological features of kidney disease in elderly patients.. We retrospectively analyzed the results of 4,185 consecutive renal biopsies, and 288 patients aged >60 years at the Second Hospital of Jilin University from January 1998 to December 2013 were finally included. All patients had been clinically and histologically diagnosed with kidney disease.. Nephrotic syndrome was the main clinical indication for biopsy. Twenty-four patients (8.33 %) experienced a minor complication related to their biopsy procedure. Among patients diagnosed as primary glomerulonephritis (GN), membranous nephropathy (MN) was the most frequent subclassification (24.7 %), followed by mesangioproliferative glomerulonephritis (MsPGN, 11.1 %) and IgA nephropathy (IgAN, 8.0 %). Amyloidosis (8.7 %) was the most common secondary GN, followed by antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune GN (5.2 %) and diabetic nephropathy (DN, 3.8 %). Based on renal biopsies results, 143/288 patients received immunosuppressive therapy and showed an overall remission rate (complete plus partial remissions) of 74.1 %. Among 71 MN patients, 29 patients received steroids plus cyclophosphamide and showed a remission rate of 79.3 %, while 42 patients received steroids and tacrolimus and showed a remission rate of 90.5 %. Among 25 patients with amyloidosis, 22 cases received melphalan plus dexamethasone and showed a remission rate of 40.9 %, while three patients received vincristine, adriamycin, and dexamethasone and showed a remission rate of 66.7 %.. Making an accurate pathologic diagnosis by renal biopsy is crucial for selecting the proper treatment for elderly patients with kidney disease.

Topics: Aged; Aged, 80 and over; Amyloidosis; Anti-Inflammatory Agents; Antibodies, Antineutrophil Cytoplasmic; Antineoplastic Agents, Alkylating; Autoimmune Diseases; Biopsy; Cyclophosphamide; Dexamethasone; Diabetic Nephropathies; Female; Glomerulonephritis, IGA; Glomerulonephritis, Membranoproliferative; Glomerulonephritis, Membranous; Humans; Immunosuppressive Agents; Kidney; Kidney Diseases; Male; Melphalan; Middle Aged; Nephrotic Syndrome; Retrospective Studies; Tacrolimus; Treatment Outcome

The objective of this study is to determine if immune reconstitution of FOXP3+ T regulatory cells correlates with clinical improvement of IPEX syndrome following allogeneic hematopoietic stem cell transplant. An 8-months-old male infant with a mutation in the polyadenylation site of FOXP3 gene, absence of FOXP3 protein expression and clinical manifestations of IPEX syndrome, including eczema, colitis, failure to thrive, TPN requirement, and elevated serum IgE, underwent matched unrelated hematopoietic stem cell transplant. After reduced-intensity conditioning with alemtuzumab followed by fludarabine and melphalan the patient's neutrophils engrafted day +15 and platelets day +29. Patient was a full donor chimera day +28 and +60. Intracellular FOXP3 protein expression in CD4+ T cells was absent pre-HSCT. After transplantation, percentage CD4+ T cells expressing FOXP3+CD25 bright phenotype quickly increased from 4.5 (day +29) to 23% (day +90) and continued in this trend. Foxp3 mRNA expression confirmed flow cytometry data. Serum IgE levels decreased from 5,000 IU/ml pre-transplant to 6 IU/ml on day +90, eczema resolved, and secretory diarrhea and feeding intolerance improved. T regulatory cell reconstitution is evident soon after HSCT following reduced-intensity conditioning correlating with development of full donor chimerism. Increased FOXP3 expression correlates with correction of clinical and laboratory manifestations of IPEX syndrome providing direct evidence that HSCT is a curative procedure for this disorder.

Topics: Alemtuzumab; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm; Antineoplastic Agents; Autoimmune Diseases; Bone Marrow Transplantation; Forkhead Transcription Factors; Hematopoietic Stem Cell Transplantation; Humans; Immunoglobulin E; Infant; Interleukin-7 Receptor alpha Subunit; Male; Melphalan; T-Lymphocytes, Regulatory; Transplantation Conditioning; Vidarabine; X-Linked Combined Immunodeficiency Diseases

Five years ago (in September, 2003), the activity of the 5th Haemopoietic Stem Cell Transplantation Centre of Hungary has begun. This centre has been registered as No 648. by the European Group for Blood and Marrow Transplantation-Centres.. To supply the needs of stem cell transplantation regions in north-east Hungary and to develop an active co-operation with the Hungarian and international centres.. Transplantations were made according to international criteria.. 150 autologous stem cell transplantations has been performed so far, including 74 patients with myeloma multiplex, 43 patients with non-Hodgkin lymphoma, 27 patients with Hodgkin's disease, 4 patients with autoimmune disease, and one patient with leiomyosarcoma. The survival rates were similar to the previous Hungarian and international data. The centre played a role in other activities using stem cell therapy at the University of Debrecen (dendritic cell vaccine program, stem cell therapy in myocardial infarction, stem cell therapy in peripheral arterial- and autoimmune diseases). This centre performed the largest quantity of the conditioning protocol Zevalin, Bischloronitrosourea, Etoposide, cytosine-Arabinoside, Melphalan in non-Hodgkin lymphoma in Hungary; ten patients were treated with this protocol.

Topics: Antibodies, Monoclonal; Antineoplastic Combined Chemotherapy Protocols; Autoimmune Diseases; Cytarabine; Etoposide; Hematopoietic Stem Cell Transplantation; Hodgkin Disease; Humans; Hungary; International Cooperation; Kaplan-Meier Estimate; Leiomyosarcoma; Lymphoma, Non-Hodgkin; Melphalan; Multiple Myeloma; Nitrosourea Compounds; Time Factors; Transplantation Conditioning; Transplantation, Autologous; Treatment Outcome

Topics: Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Autoimmune Diseases; Female; Humans; Liver Cirrhosis, Biliary; Melphalan; Middle Aged; Multiple Myeloma; Prednisolone

There have been a number of reports on the improvement of concomitant autoimmune disease (AID) after autologous hematopoietic stem cell transplantation (SCT) performed for hematologic malignancy. However, in some cases of hematologic malignancy with AID, exacerbation of AID after autologous SCT has been reported. We have treated 27 adults with multiple myeloma with single or tandem autologous SCT. After peripheral blood stem cells were collected and stored without CD34+ cell selection or T-cell depletion, all patients received melphalan (200 mg/m2) as a conditioning regimen. In 2 patients with a history of AID (one with rheumatoid arthritis [RA] and the other with bullous pemphigoid [BP]) and in 1 patient with Sjögren syndrome, AID recurred 7 to 12 months after autologous SCT. The RA and BP were in durable remission before SCT, and no Sjögren syndrome-related disease activity was clinically documented at the time of SCT. No progression of the myeloma was observed when the AIDs recurred. The patients required systemic steroid therapy for their AID, and successful control of the disease was achieved. Our experience suggests that autologous SCT with unmanipulated stem cells for myeloma is unlikely to cure preexisting AID; rather, the AID may worsen. Transplantation physicians should be aware of this possible complication.

Topics: Aged; Antigens, CD34; Arthritis, Rheumatoid; Autoimmune Diseases; Female; Humans; Lymphocyte Depletion; Male; Melphalan; Middle Aged; Multiple Myeloma; Pemphigoid, Bullous; Peripheral Blood Stem Cell Transplantation; Recurrence; Sjogren's Syndrome; Steroids; Transplantation Conditioning; Transplantation, Autologous

Thalidomide, an agent with antiangiogenic and immunomodulatory properties, is therapeutically effective in multiple myeloma, leprosy, and autoimmune diseases. The most common clinical toxicities of thalidomide are constipation, neuropathy, fatigue, sedation, rash, tremor, and edema. We here describe for the first time a patient who developed leukocytoclastic vasculitis during therapy with thalidomide. Of the 260 patients treated with thalidomide in our institution, this is the first patient who developed autoimmune disease. We conclude that patients with malignant disorders who are treated with thalidomide should be carefully monitored for the development of autoimmune disorders. Whether autoimmune phenomena also occur during treatment with new drugs such as PS-341 or potent immunomodulatory agents remains to be evaluated.

Topics: Adjuvants, Immunologic; Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Autoimmune Diseases; Clinical Trials as Topic; Combined Modality Therapy; Cyclophosphamide; Dexamethasone; Humans; Idarubicin; Immunosuppressive Agents; Male; Melphalan; Middle Aged; Multiple Myeloma; Peripheral Blood Stem Cell Transplantation; Prednisolone; Prednisone; Thalidomide; Vasculitis, Leukocytoclastic, Cutaneous; Vincristine

Topics: Adenocarcinoma; Autoimmune Diseases; Autopsy; Bone Marrow; Breast Neoplasms; Female; Humans; Immunoglobulin G; Leukemia; Melphalan; Middle Aged; Multiple Myeloma

Topics: Adult; Autoimmune Diseases; Azathioprine; Blood Cell Count; Busulfan; Cyclophosphamide; Female; Humans; Hypersensitivity, Delayed; Immunosuppressive Agents; Male; Melphalan; Mercaptopurine; Methotrexate; Myasthenia Gravis

Topics: Adrenal Cortex Hormones; Adult; Amyloidosis; Autoimmune Diseases; Bence Jones Protein; Cold Temperature; Cryoglobulins; Humans; Hyperlipidemias; Immunoglobulin M; Male; Melphalan; Mucous Membrane; Multiple Myeloma; Mycosis Fungoides; Osteoporosis; Plasma Cells; Plasmacytoma; Purpura, Hyperglobulinemic; Pyoderma; Skin Manifestations; Skin Ulcer; Tongue; Xanthomatosis