Blood and Marrow Transplantation Reviews: Volume 13, Issue 5
Introduction: Staunching the Flow to Prevent a Blood Bath
by John R. Wingard, MD, Editor
Bleeding is a major complication of bone marrow failure. Without
advances in transfusion technology, management of severe
thrombocytopenia would be difficult and hematopoietic cell
transplantation (HCT) would be impractical. Transplant clinicians
have focused less on the soluble factors responsible for clotting
than on the cellular component. Yet bleeding complications can
pose enormous problems, such as hemorrhagic cystitis and diffuse
alveolar hemorrhage. Both pose threats to life, and management
strategies are poorly developed. Enormous advances have been made
in the understanding of coagulation in health and illness. With
improved insights, new reagents to compensate for deficits in
disease states have followed.
In this issue, the proceedings of a satellite symposium presented
at the Tandem BMT Meetings in Keystone in February 2003 address
the topic of excessive bleeding in the HCT setting and options
for management. First, the coagulation cascade is reviewed and a
newer cell-based model of hemostasis is described that was
developed to attempt to explain several clinical conditions that
the older models did not adequately explain. Next follows a
discussion of two hemorrhagic complications after HCT.
Hemorrhagic cystitis and diffuse alveolar hemorrhage are bleeding
conditions that are poorly understood and for which there are no
known effective treatment strategies. Several promising therapies
that have been tested in pilot studies are discussed. Finally,
several anecdotes using high doses of Factor VIIa in other
hemorrhagic conditions are discussed.
This symposium serves to emphasize the need to develop greater
understanding of these hemorrhagic complications of HCT. Clearly
there is also a need for rigorous trials of promising agents,
available now for other medical indications, to determine if
their potential for help in the HCT setting is real.
In this issue:
Introduction
Staunching the Flow to Prevent a Blood Bath
John R. Wingard, MD
Membership Application
Symposium Review:
Excessive Bleeding in Bone Marrow
Transplantation: New Treatment
Options Improve Outcome
Maureane Hoffman, Donald Gabriel,
Gili Kenet
Research Summaries
Minor Histocompatibility Antigen-
Specific Cytotoxic T Lymphocytes
Generated with Dendritic Cells from
DLA-Identical Littermates
George E. Georges, Marina Lesnikova,
Rainer Storb, Murad Yunusov,
Marie-Terese Little, Richard A. Nash
Host Conditioning with Total Lymphoid
Irradiation and Antithymocyte Globulin
Prevents Graft-versus-Host Disease:
The Role of CD1-Reactive Natural Killer
T Cells
Fengshuo Lan, Defu Zeng, Masanori Higuchi,
John P. Higgins, Samuel Strober
Recombinant Human Thrombopoietin
Augments Mobilization of Peripheral
Blood Progenitor Cells for Autologous
Transplantation
Charles Linker, Paolo Anderlini, Roger Herzig,
Neal Christiansen, George Somlo,
William Bensinger, Joseph Fay, Joseph P. Lynch,
Lawrence T. Goodnough, Mark Ashby,
Mark C. Benyunes, Dennie V. Jones,
Timothy A. Yang, Langdon L. Miller,
Charles Weaver
Journal Watch
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