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Biomedical subjects

R Giller

Publications and source records attributed to R Giller.

24 records · Page 2Linked to original sources
PubMed1989

Low rejection rate when using unrelated or haploidentical donors for children with leukemia undergoing marrow transplantation.

Thirty-nine children with leukemia were entered into a bone marrow transplantation study comparing the use of unrelated donors who were HLA-Dr identical and matched at least with three of the four HLA-A or B loci, with haploidentical related donors. Although marrows were prepared by T lymphocyte depletion in vitro, the rejection rate of marrow in these patients was only 13% (5/39). Four patients had early rejections, and three of these four had autologous recovery immediately without evidence of leukemic recurrence. The fifth had a delayed rejection occurring approximately 2 1/2 months after transplant. These results were achievable by an ablative regimen incorporating increased immunosuppression. Although the small sample size does not yet permit evaluation of outcome comparing one donor type versus another, the early findings document a high rate of successful engraftment.

Adolescent↗
PubMed1988

Aspergillus coronary embolization causing acute myocardial infarction.

An increased frequency of disseminated aspergillosis has been observed in the last decade, mostly occurring in immunocompromised patients including the bone marrow transplant population. Cardiac involvement by Aspergillus remains rare. We report the clinical and postmortem findings of an unusual case of Aspergillus pancarditis in a 7-year-old bone marrow transplant patient with Aspergillus embolization to the coronary arteries leading to a massive acute myocardial infarction. This case suggests that myocardial injury secondary to disseminated aspergillosis should be included in the differential diagnosis of chest pain in the immunocompromised pediatric patient.

Aspergillosis↗
PubMed1987

Murine cytomegalovirus genomic material in marrow cells: relation to altered leukocyte counts during sublethal infection of mice.

To investigate infection of hematopoietic cells by murine cytomegalovirus (MCMV), we used in situ hybridization to detect MCMV genomic material in marrow cells during sublethal infection of three-week-old mice. MCMV genomic material was present in femoral marrow cells on days 3, 5, 7, and 14, and detection of MCMV genomes correlated strongly with recovery of infectious virus. Peak infection occurred on day 5, when 0.003%-0.185% of the marrow cells contained MCMV genomic material. At peak infection, MCMV genomic material was observed predominantly in marrow mononuclear cells. Coincident with marrow infection, mice experienced significant leukopenia, whereas cessation of MCMV replication in marrow cells was associated with leukocytosis and restoration of normal peripheral blood leukocyte counts.

Animals↗
PubMed1986

Millipore filter vs cytocentrifuge for detection of childhood central nervous system leukemia.

To evaluate the relative merits and deficiencies of Millipore filter and cytocentrifuge preparations in the detection of central nervous system (CNS) acute leukemia in pediatric patients, 300 cerebrospinal fluid (CSF) specimens from 17 patients were prepared by both methods. The 17 patients studied were all diagnosed and treated for CNS leukemia. Leukemic blast cells were found by at least one method in 91 CSF specimens, and the results of both techniques were positive in 77 (85%) of 91 specimens. Of the 14 specimens in which the results of only one method were positive, seven yielded positive results only by the cytocentrifuge method, and seven yielded positive results only by the Millipore filter method. In 12 of the 14 discrepant specimens, the paired specimen whose results were not interpreted as positive was technically unsatisfactory (nine specimens) or had cells suspicious for blast cells rather than unequivocal blast cells (three specimens). Blast cells were identified in specimens with low nucleated cell counts (less than or equal to 5/mm3) by both methods and usually were immediately preceded or followed by CSF specimens showing florid disease. We conclude that performance of both methods is unnecessary for routine surveillance if processing techniques yield quality preparations. Cytocentrifuge preparations stained by Wright's method allow better morphologic correlation with bone marrow blast cells and allow easier identification of blood or bone marrow contamination.

Adolescent↗
PubMedDate not supplied

Microchimerism and tolerance following intrauterine transplantation and transfusion for alpha-thalassemia-1.

A fetus homozygous for alpha-thalassemia-1 was given haploidentical paternal CD34 cells at 13, 19 and 24 weeks' gestation and supported through pregnancy by blood transfusion. The fetal hematocrit ranged between 27 and 47% and between one half and three quarters of this hemoglobin was of recipient (Bart's) type. Intrauterine growth proceeded normally and no significant fetal hydrops was detected. Tests for donor HLA antigens, and alpha-globin DNA, were negative on fetal blood samples drawn before birth. A positive signal for alpha-globin DNA was obtained from cord blood and from marrow obtained at 3 months of age, suggesting that some donor stem cells had persisted in the recipient. The infant's blood mononuclear cells showed little proliferative and no cytotoxic response to the donor while responses to a third party were present. Additional paternal CD34 cells given at 3 months age did not reduce transfusion dependency in the subsequent 6 months. Our results show that repeated transfusions can support an alpha-thalassemia-1 fetus through pregnancy, in this instance without significant birth defects or apparent hypoxic tissue injury. The donor stem cells did not have a survival advantage compared with endogenous stem cells, but appeared to survive in the recipient as judged by the persistence of an alpha-globin DNA signal. In vitro studies of alloreactivity suggest tolerization of the host to the donor's MHC disparity. Future efforts will focus on exploiting this tolerance to improve the level of donor chimerism.

Antigens, CD34↗