Late-onset hemorrhagic cystitis (HC) is a well-known complication of bone marrow transplantation (BMT) that is mainly attributed to infection with BK virus (BKV) and adenovirus (AdV). From 1986 through 1998, 282 patients underwent BMT, and 45 of them developed HC. Urine samples tested positive for AdV in 26 patients, of which 22 showed virus type 11. Among patients who underwent allogeneic BMT, logistic regression analysis revealed acute graft-versus-host disease (grade, > or = 2) to be the most significant predictive factor for HC (P < .0001). In addition, a total of 193 urine samples regularly obtained from 26 consecutive patients who underwent allogeneic BMT were examined for BKV, JC virus (JCV), and AdV by means of polymerase chain reaction. Of patients without HC, approximately 30% of the specimens tested positive for BKV (58 samples) and JCV (55 samples), whereas 5 (3%) tested positive for AdV. Of the 3 samples obtained from patients with HC, the numbers of positive results for BKV, JCV, and AdV were 3, 1, and 1, respectively; the numbers of positive results increased to 14 of 17, 9 of 17, and 10 of 17, respectively, when we added another 14 samples obtained from 14 patients with HC (P < .0001, P = .026, and P < .0001, respectively). In conclusion, there was significant correlation between AdV and HC in the patients we studied.

Background. It was assessed whether addition of vincristine (VCR) to remission induction therapy would increase the complete remission (CR) rate, and, secondarily, whether 12 courses of maintenance—intensification therapy would produce longer survival than 4 courses in adult acute myeloid leukemia (AML). Methods. A randomized comparison of individualized induction therapy was conducted between daunorubicin, behenoyl cytarabine, 6‐mercaptopurine, and prednisolone with or without VCR. After 3 courses of intensive consolidation therapy, maintenance—intensification therapy was randomized to 4 or 12 courses given every 6 weeks. Results. Of 265 patients registered, 252 were evaluable. CR was obtained in 78%; 80% in 205 patients of age younger than 60 years, and 65% in 47 of age 60 years or older. Addition of VCR reduced the CR rate significantly (84% to 70%, P = 0.007). Predicted 4‐year survival, continuing CR, and disease‐free survival (DFS) rates of 196 CR patients are 45%, 41%, and 35%, respectively. Patients receiving 12 courses of maintenance—intensification showed better DFS. By multivariate analyses, significant factors for achievement of CR were performance status 0 to 2, age younger than 60 years, and no VCR; and those for longer DFS were achievement of CR by one course, age younger than 50 years, and French—American—British (FAB) classification M3 or M5. Among 131 patients randomized to the maintenance, the administration of 12 courses was the most important factor (P = 0.0040) for longer DFS, followed by FAB M3 or M5, and by achievement of CR by one course. Conclusions. Addition of VCR in remission induction therapy was harmful, and longer intensive maintenance therapy prolonged DFS in adult AML.

More effective antifungal agents are required for the treatment of infections with this organism.

Summary:therefore determined the incidence of VOD using the McDonald's criteria and analyzed the clinical characteristics of patients with VOD and those without it. One hundred and thirty-seven consecutive patients who received bone marrow or peripheral blood stem cell transplantation were studied retrospectively to identify the risk factors for hepatic veno-occlusive disease Materials and methods (VOD). Of the 137 recipients, twenty (14.6%) patients were diagnosed with VOD using the McDonald's criPatients teria. In these 20 patients with VOD, we analyzed various clinical parameters, including age, sex, HLA status, One hundred and thirty-seven consecutive patients (52 conditioning regimen, irradiation, immunosuppressive males and 85 females) underwent bone marrow transplanagents, mode of transplantation, history of hepatic dystation (including peripheral blood transplantation) for function, pre-transplant hepatic and renal function, hematological malignancies and severe aplastic anemia at infectious episodes, antibiotics use, and serum viral titour institution between September 1989 and October 1995. ers. A history of hepatic dysfunction and low levels ofThe average age of patients was 29.9 (6-51) years old. pseudocholinesterase before transplantation were found to be statistically significant (P = 0.04 and 0.04). LowConditioning regimens and graft-versus-host disease levels of pseudocholinesterase were significant by multi-(GVHD) prophylaxis variate analysis using the logistic regression model (P = 0.02). These results suggest that pseudocholinester-The primary disease for which transplantation was carried ase levels before transplant are important markers of out, transplantation procedures and immunosuppressive VOD in patients receiving BMT.agents used are summarized in Table 1.

Summary:mechanisms of the onset of hepatitis after BMT in patients with positive HCV antibody. The hepatitis C virus (HCV) infection has, in general, been considered not to affect liver function severely durCase reports ing the course of bone marrow transplantation (BMT) except for late hepatitis which coincided with a decrease Case 1 in immunosuppressive therapy. We examined serial sera of two patients with positive HCV antibody who A 32-year-old woman underwent allogeneic BMT from a underwent allogeneic BMT and found that while the sibling donor for acute myelogenous leukemia. Before dose of cyclosporin A tapered off, the serum concen-BMT, her aspartate aminotransferase (AST) and alanine tration of HCV core protein increased before the occuraminotransferase (ALT) levels were 21 and 35 IU/l, rence of hepatitis. This suggests that viral reactivation respectively, and her anti-HCV antibody test was positive. and growth might be one of the important mechanisms CsA was given intravenously until 61 days after BMT, of hepatitis after BMT in patients with positive HCV when it was changed to the oral form. Except for a transient antibody.increase in AST and ALT levels shortly after BMT, no