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Aspergillosis is known for the variety of unusual presentations in immuno-suppressed patients. We report a patient in whom aspergillosis caused the superior vena cava (SVC) syndrome. A 37-year-old woman became febrile soon after bone marrow transplantation (BMT). Chest radiography demonstrated a 5-cm mass extending from the right lung apex to the right supraclavicular fossa beside her Hickman catheter. She then developed SVC syndrome, which progressed despite treatment. Despite recovery of the white blood cell count, the patient continued to deteriorate, became comatose, suffered a cardiac arrest and died 31 days after BMT. Autopsy revealed Aspergillus infection at the apex of the right lung associated with innominate artery thrombosis.

Viral infections are an important cause of death following bone marrow transplantation. We investigated the clinical significance of herpesvirus infection. The nine subjects consisted of five patients with CML, two with ALL, and one each with AML and the myelodysplastic syndrome. Viral markers were investigated in bronchoalveolar lavage fluid and peripheral blood lymphocytes before and 35 days after bone marrow transplantation, as well as in peripheral blood lymphocytes at 100 days afterwards. Cytomegalovirus DNA became positive in four patients after bone marrow transplantation. Human herpesvirus-6 DNA became positive in two patients and human herpesvirus 7 DNA became negative in the same two patients. Two of the nine patients died of disease recurrence. Two other patients died of complications, and both of them became positive human herpesvirus-6 after the procedure. These results suggested the possibility that infection with not only cytomegalovirus but also other human herpesvirus can influence the prognosis and complications of bone marrow tansplantation.

Colonic graft-versus-host disease (GVHD) occurring after allogeneic bone marrow transplantation (BMT) resembles ulcerative colitis (UC) with respect to pathological features. In addition, therapy for UC has been reported to be effective for the treatment of refractory GVHD. The relationship of these two conditions with respect to cytokines was investigated in the present study. Among 27 patients who underwent allogeneic BMT during the previous two years, six developed GVHD of grade 3 or higher, and these six patients were compared with the other 21 patients. In six patients, the levels of the following cytokines were significantly elevated at the onset of GVHD: tumor necrosis factor-α (p

The outcome of sixty-four patients with acute leukemia in first remission who had been treated with either bone marrow transplantation (BMT) or conventional chemotherapy was retrospectively evaluated (a median follow-up of 37 months). Among them, 26 patients (age range; 14-42 years) received allogeneic BMT from HLA-identical siblings and 38 patients (age range; 13-43 years) who had no HLA-identical donors undertook the continued combination chemotherapy. Kaplan-Meier product-limit estimate of actuarial survival of acute myelogenous leukemia (AML) patients was 48.9% for the BMT group and 15.7% for the chemotherapy group (p = not significant, NS). For acute lymphoblastic leukemia (ALL) patients, the survival following BMT was 80.2% and was significantly higher than that of the chemotherapy group of 33.3% (p0.05). The disease-free survival of AML and ALL for the BMT group was 34.3% and 36.5%, respectively, which was higher than that of the chemotherapy group (16.7% and 23.4%, respectively (p = NS)). These findings in our Japanese single institution study suggested that BMT may be the treatment of choice for adult patients with acute leukemia in first remission if they had suitable donors and that more effective therapeutic regimens were necessary for patients without compatible donors in order to obtain the longer remission duration.