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Biomedical subjects

W Helbig

Publications and source records attributed to W Helbig.

At least 37 records · Page 2Linked to original sources
PubMed1989

Acute and late effects in the course of and after total body irradiation with following bone marrow transplantation in patients with different forms of leukaemia.

The acute reaction in the course of a total body irradiation (TBI) appears in an organ-specific damage of the stem cells. Moreover, there are unspecified central-nervous stress reactions. Clinical reactions are obtained by the study and symptomatic therapy is proposed. 90 patients with different forms of leukaemia were observed. We documented the course in a specific "protocol system". Reactions like an increase of body temperature, changes of pulse and blood pressure were registered. The occurrence of gastro-intestinal reactions is a typical symptom of the acute radiation syndrome e.g. vomiting and diarrhoea are demonstrated in dependence of the applicated dose of irradiation. Further symptoms of TBI appeared in the later period. Mucositis, parotitis, a decreased function of the salivary glands and diarrhoea as well as vomiting are characterized by different intensity and temporary termination. A difference between allogeneic and autologous transplantation is caused by a medicamental additional treatment. During the late period these symptoms will disappear completely. Moreover, after TBI and BMT late effects are a cataract and some changes in the hormonal system demanding a specific correction or substitution respectively.

Adolescent↗
PubMed1989

Autologous bone marrow transplantation (ABMT) using unpurged marrow as intensification for first complete remission in acute leukaemia (AL).

In order to assess the clinical advantage of autologous bone marrow transplantation (ABMT) without ex vivo purging, the results in 26 patients (10 AML, 16 ALL) in 1. CR were analyzed retrospectively. All patients received 3 consolidation cycles "in-vivo purging" before marrow harvesting. Beside relapses infections and cardiac failure were the most frequent complications. After 1 to 12.5 months 11 cases relapsed with a higher probability in patients who had a longer period of induction and between CR and ABMT. 12 patients became relapse-free survivors 6 to 53 months after ABMT with a stable plateau after 12.5 months for 8 patients. In conclusion, ABMT following "in-vivo purging" as the strongest one-step postremission therapy in patients with acute leukaemias may be a way for better long-term results in these patients.

Adolescent↗
PubMed1989

Immune recovery following bone marrow transplantation.

83 patients undergoing allogeneic or autologous BMT because of haematologic malignancies have been studied before and after transplantation at different intervals. The determinations consisted of lymphocyte counts, E-rosetting, lymphoblastic response, evaluation of serum immunoglobulin levels, skin testing, and in a smaller part of the patients surface marker studies using monoclonal antibodies of the BL-series. At first after BMT the lymphocyte and T cell counts went to normal between 4-18 weeks post transplant, about 4 weeks earlier in autologous than in allogeneic BMT. T suppressor cells showed an early increase compared to T helper cells which normalized much slower about 6 months after BMT. Lymphoblastic responses, however, tended to normal not before the second half of the first year both in autologous and allogeneic transplantation. Skin test reactivity became normal during the 2nd and 3rd year posttransplant, which was more complete in autologous than in allogeneic BMT. The IgG and IgM levels were depressed for half a year and IgA levels for 2 years. The most striking aspect was the multiphase course of lymphoblastic response in every individual patient. We suggest this to be the expression of sequential differentiation of donor lymphocytes.

Anemia, Aplastic↗
PubMed1989

Endocrine dysfunction after total body irradiation and bone marrow transplantation.

The present report describes our data regarding changes of endocrine parameters after total body irradiation (TBI) and bone marrow transplantation (BMT). Endocrine glands are usually resistant to irradiation under morphological aspects. But new methods of determination and sensitive tests were developed in the last few years. Now it is possible to detect already small functional changes. Endocrine studies in the course of the disease were followed serially at 16 patients with TBI and BMT. Pretransplant conditioning consisted of single-dose irradiation combined with a high-dose, short-term chemotherapy. Reactions of the endocrine system showed a defined temporary order. Changes of ACTH and cortisol were in the beginning. The pituitary-adrenal cortex system responds in a different way. The pituitary-thyroid system develop a short-term "low-T3-syndrome" reflecting the extreme stress of the organism. At the same time we obtained an increase of thyroxine. Testosterone and luteotropic hormone, the sexual steroids showed levels representing a primary gonadal insufficiency. The studies in the posttransplant period yielded a return to the normal range at most of the hormonal levels with the exception of the sexual steroids. Sterility is one of the late effects of TBI. A tendency towards hypothyroidism could be noticed in some cases being only subclinical forms. Reasons and possible therapy are discussed.

Adrenocorticotropic Hormone↗
PubMed1989

Germ monitoring of patients, staff and environment in reverse isolation.

To estimate the efficiency of germ-poor for patients who underwent BMT or ABMT in reverse isolation we investigated the staff, patients and the environment of the BMT unit bacteriologically and mycologically between 1/85 to 3/87. On patient's body surface gram-negative germs were not estimated but coagulase negative staphylococci persisted. Only in few cases aerobic spores were detectable, seldom enterococci, corynebacterium and fungi. Staff members had a distinct higher grade of contamination inside the BMT-unit but outside of isolation rooms. We found sporadically staphylococcus aureus and germs of the mouth cavity on hands and fore head. Although gram negative rods were seldom detected in environmental studies, humid regions of the ward remain to be problematic zones.

Bacteria↗
PubMed1989

Lethal complications in 30 patients after allogeneic BMT (BMT) and autografted (ABMT) patients (1980-1986) examined by autopsy.

Lethal and accompanying complications from 29 allogeneic, 8 autologous, and 1 syngeneic transplanted pts., died between 1980 and 1986 at the BMT-Center Leipzig were revisited. An important problem was that of systemic and local infections. We observed a predominance of bacterial and fungal infections within the first 3 weeks p.t., and later on a period of predominantly virus-associated infections. The most common early death (up to 3 months p.t.) was related to ICP, as a rule caused by CMV. GvHD was a common finding at autopsy, and GvHD of the bowel seems to facilitate infectious inflammations of the bowel. There was a positive correlation between severe GvHD and the occurrence of ICP. Neither of the died BMT pts. showed signs of relapse. After ABMT ICP did not occur. The lethal complications were septicaemia, local infections, relapse and haemorrhagic diathesis. A toxic effect of DMSO in 3 pts. must be taken into account. In conclusion, a rather small number of lethal factors indicates the steps in improving results of transplantation in the future.

Adolescent↗
PubMed1989

Growth of hemopoietic cells after incubation with VP 16-213.

We examined the effect of various concentrations of VP 16-213 (25-125 microM/l, 2-h incubation on normal and complete remission bone marrow from patients with acute leukaemia and on leukaemic blasts. The maximal tolerated dose of the drug for normal bone marrow GM-CFC was between 75 and 100 microM/l whereas that for complete remission bone marrow was distinctly lower. More early stem cells measured by aid of LTBMC were more resistant in normal, but not in every remission bone marrow. We have to examine if these LTBMC results are influenced by a damaged microenvironment by using 2 stage LTBMC. Spontaneous leukaemic cells showed a different, sometimes lower sensitivity to VP 16-213 doses maximally tolerated by normal hemopoietic cells so that the VP 16-213 incubation must not be effective for every leukaemia.

Bone Marrow↗
PubMed1988

[Blood cell substitution within the scope of hematologic intensive therapy for supportive hemotherapy with erythrocyte, thrombocyte and granulocyte concentrates].

Nowadays the application of blood cell concentrates corresponding to indication is in nearly all cases superior to the whole-blood transfusion. For the substitution of erythrocytes are to be recommended buffy coat-free concentrates, for special indications also cryopreserved ones in order to avoid complications (sensitization, transmission of viruses). Concentrates of thrombocytes are to be administered nearly exclusively in disturbances of formation and may be used for the short-term application as pooled randomized preparations, in a medium period better may be used as individual donor preparation. In order to avoid sensitizations, but always when HLA-antibodies occur, HLA-compatible individual donor concentrates must be used. Particularly in the patient with immune deficiency the possible transmission and the growth of stem cells with subsequent graft-versus-host disease (therefore the concentrates should be irradiated with 15-30 Gy) and the transmission of cytomegaly viruses (CMV), respectively, which can be minimized using CMV-negative donors, is to be taken into consideration. Prophylactically applied concentrates of thrombocytes evidently co-determine the therapeutic success of the highly aggressive chemotherapy; transplantation of bone marrow could not be performed without them. On account of the danger of the transmission of CMV concentrates of granulocytes are administered only strongly therapeutically in life-threatening infections, when the patient shows a decrease of the number of granulocytes below 0.5 Gpt/l. However, the substitution must be performed consequently over at least 3 days and up to the proof of clinical effectiveness, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Grouping and Crossmatching↗
PubMed1987

[The value of cell cultures in leukemias, aplastic anemias and bone marrow transplantations].

In a survey different methods of culture are represented for the purpose of identifying and quantifying haemopoietic stem cells (CFU-GEMM, CFU-GM, CFU-E/BFU-E) in human bone-marrow or peripheral blood respectively. On the basis of findings from international medical literature their validity is explained in the diagnostics and prognosis of some haematological diseases, such as acute and chronic myeloic leukemia, aplastic anemia, preleukemia. Special attention is given to their significance within bone-marrow transplantation. Their importance in evaluating transplantations after their preceding in-vitro manipulation as to the separation of rest tumour and T-cells is particularly referred to.

Anemia, Aplastic↗
PubMed1986

Autologous bone marrow transplantation for acute leukaemia in remission.

Between 1980 and 1985, 175 patients with acute leukaemia in first or subsequent complete remission (CR) were treated by chemotherapy or chemoradiotherapy followed by transfusion of autologous bone marrow cells that had been collected days or months previously. In 85 cases, autologous marrow cells were treated ex vivo with cytotoxic drugs or monoclonal antibodies with the intention of removing residual leukaemic cells. The actuarial relapse-free rate was 52% at 2 years. Of 89 patients autografted for acute non-lymphocytic (myeloid) leukaemia (ANLL), 60 were treated in first remission and 18 in second CR; their relapse-free rates at 2 years were 67% and 41% respectively (P less than 0.001). In contrast, of 77 patients autografted for acute lymphoblastic leukaemia (ALL), 32 were treated in first CR and 28 in second CR and their actuarial relapse free rates at 2 years were 56% and 55% respectively (P = NS). There was no significant difference in leukaemia relapse rates between patients autografted with purged and those autografted with non-purged marrow cells. These preliminary results suggest that autologous bone marrow transplantation may be valuable if offered to patients with ANLL in first CR or to patients with ALL in first or second CR but the need for marrow purging remains uncertain.

Acute Disease↗
PubMed1983

[Therapy results of acute leukemia 1965-1980].

At the instance of 174 patients with leukemia is demonstrated that the development to a more aggressive cytoreductive chemotherapy during the last 15 years achieved success without increasing the risk of treatment. A decisive improvement of prognosis for the acute leukemia of adult age is, however, to be expected only from new methods.

Acute Disease↗
PubMed1983

[Prognosis-oriented therapy of aplastic anemia].

From catamnestic examinations of the prognosis of patients with aplastic anaemias and the modern international level of the treatment is to be derived that in all severe forms the most favourable results of the therapy are to be achieved by the transplantation of bone marrow. Therefore, in the tentative diagnosis "severe aplastic anaemia" an immediate transfer into a haematologic centre for the purpose of aseptic care, further diagnostics and therapy is indicated. On the basis of a short review of the level of the modern possibilities of therapy further recommendations relevant to practice are derived.

Anemia, Aplastic↗