thioguanine-anhydrous and Virus-Diseases

Topics: Animals; Antibody Formation; Arbovirus Infections; Chiroptera; Culture Techniques; Disease Models, Animal; Disease Reservoirs; Encephalitis Virus, Japanese; Encephalitis Virus, St. Louis; Encephalitis, Japanese; Encephalitis, St. Louis; Endotoxins; Interferons; Rabies; Rabies virus; Temperature; Thioguanine; Virulence; Virus Diseases

Topics: Abnormalities, Drug-Induced; Adult; Aged; Azathioprine; Bone Marrow Diseases; Chemical and Drug Induced Liver Injury; Child; Cost-Benefit Analysis; Drug Administration Schedule; Drug Approval; Drug Costs; Drug Hypersensitivity; Drug Interactions; Female; Genetic Testing; Humans; Immunosuppressive Agents; Infections; Kidney Diseases; Lactation; Male; Methyltransferases; Nausea; Neoplasms; Off-Label Use; Patient Education as Topic; Pregnancy; Risk Factors; Skin Diseases; Thioguanine; Virus Diseases

A 19-yr-old boy has been in continuous complete remission from acute myelogenous leukemia for 3 yr after allogeneic bone marrow transplantation prepared with combination chemotherapy. During the first year post-transplant, however, the patient developed near-fatal graft-versus-host reaction followed by 11 severe viral and bacterial infections. Immune evaluation during this period revealed multiple defects which were not present prior to transplantation, nor present in the transplant donor: diminution of lymphoid tissue, decline of all immunoglobulin subtypes, deletion of secretory immunoglobulin, disappearance of isohemagglutinins, loss of antibody to diptheria and tetanus toxoids, cessation of cutaneous hypersensitivity to mumps antigen, and inhibition of serum opsonizing activity. The patient was also unable to develop normal humoral or cellular reactivity to brucella antigen, keyhole limpet hemocyanin, or dinitrochlorobenzene. This patient's course illustrates the severity and chronicity of immunoincompetence associated with allogeneic marrow grafting, the importance of early detection and rigorous treatment of infectious disease in these patients, and the need for improved immunologic reconstitution in human marrow transplantation. It also indicates that complete recovery from the immune defects is possible, and that long-term remission from acute myelogenous leukemia can be achieved with allogeneic marrow transplantation.

Topics: ABO Blood-Group System; Adolescent; Adult; Anti-Bacterial Agents; Antilymphocyte Serum; B-Lymphocytes; Bacterial Infections; Blood Group Incompatibility; Bone Marrow Cells; Bone Marrow Transplantation; Candidiasis; Cyclophosphamide; Cytarabine; Graft vs Host Reaction; Histocompatibility Antigens; Humans; Immunity, Maternally-Acquired; Immunologic Deficiency Syndromes; Leukemia, Myeloid, Acute; Male; Nitrosourea Compounds; Opsonin Proteins; T-Lymphocytes; Thioguanine; Transplantation, Homologous; Virus Diseases

Cytarabine is an effective agent in the treatment of acute leukemia. Since its approval by The Food and Drug Administration in 1969, the clinical effectiveness of this drug has increased as knowledge of its pharmacologic and biologic properties has been translated into clinical trials. A complete remission rate of greater than 50% can be achieved when cytarabine is used in combination with other agents in the treatment of adult acute myeloblastic leukemia. Remissions occur only after the development of significant bone-marrow hypoplasia, and the care of patients through this period of pancytopenia requires elaborate supportive techniques and facilities. The role of cytarabine in the treatment of acute lymphoblastic leukemia and lymphoma is still under clinical investigation and appears promising. Because the clinical effectiveness of cytarabine in the treatment of nonmalignant diseases has not been proved, its use in these disorders must be considered investigational and weighed against the serious bone-marrow suppression and potential long-term hazards of this drug.

Topics: Acute Disease; Adult; Animals; Bone Marrow Diseases; Central Nervous System Diseases; Cyclophosphamide; Cytarabine; Daunorubicin; DNA, Neoplasm; Drug Therapy, Combination; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Lymphoma; Prednisone; Remission, Spontaneous; Thioguanine; Vincristine; Virus Diseases

Topics: Animals; Cyclophosphamide; Encephalomyocarditis virus; Mice; Thioguanine; Virus Diseases