Bone marrow syndrome

Tissue and organ injuries, local injuries, the various syndromes of acute radiation sickness like the bone marrow syndrome, the gastro-intestinal syndrome, the vascular-nervous syndrome, and any other combinations with local radiation burns are the syndromes of deterministic effects (Barabanova et al. 2008). 

GM-CSF, G-CSF, M-CSF, multi-CSF cytotoxic injury bone marrow transplantation myelodysplastic syndromes AIDS neutropenia rodent and human... 

Decitabine is specifically indicated for the treatment of multiple types of myelodysplastic syndromes and chronic myelomonocytic leukemia. As anticipated, use of decitabine is associated with bone marrow suppression including neutropenia and thrombocytopenia which are the most frequently observed serious adverse effects. 

Streptococcus gentamicin (5 mg/kg per day, dosing based on serum levels) Alternative Therapies Trimethoprim-sulfamethoxazole (TMP-SMX) 10-20 mg/kgTMP IV per day in divided doses every 6-8 hours or meropenem Standard Therapy TMP-SMX Rash, Stevens-Johnson syndrome, bone marrow suppression, nausea/vomiting, hepatotoxicity 14-21... 

Idarubicin inhibits both DNA and RNA polymerase, as well as topoisomerase II. The pharmacokinetics of idarubicin can best be described by a three-compartment model, with an a half-life of 13 minutes, a (3 half-life of 2.4 hours, and a terminal half-life of 16 hours.22 Idarubicin is metabolized to an active metabolite, idarubicinol, which has a half-life of 41 to 69 hours. Idarubicin and idarubicinol are eliminated by the liver and through the bile. Idarubicin has shown clinical activity in the treatment of acute leukemias, chronic myelogenous leukemia, and myelodysplastic syndromes. Idarubicin causes cardiomyopathy at cumulative doses of greater than 150 mg/m2 and produces cumulative cardiotoxic effects with other anthracyclines. Idarubicin is a vesicant and causes red-orange urine, mucositis, mild to moderate nausea and vomiting, and bone marrow suppression. 

Even though chromosomal abnormalities correlate with prognosis in adult AML, they appear to have less influence on outcome. Among children, the male gender, platelet count of less than 20 x 1 03/jllL (20 x 109/L), hepatomegaly, more than 15% bone marrow blasts on day 14 of induction, myelodysplastic syndrome (MDS), and FAB sub-type M5 all were associated with lower CR rates. The absence of these features and abnormal chromosome 16 were associated with more favorable outcomes.6... 

In older adults, AML is either more likely to arise from a proximal bone marrow stem cell disorder, such as myelodys-plastic syndrome (MDS), or present as a secondary leukemia resulting from treatment with prior chemotherapy or radiation for an earlier malignancy. These forms of AML are notoriously less responsive to chemotherapy and thus have a lower CR rate and EFS.20... 

Hildebrandt GC, Duffner UA, Olkiewicz KM, et al. A critical role for CCR2/ MCP-1 interactions in the development of idiopathic pneumonia syndrome after allogeneic bone marrow transplantation. Blood 2004 103(6) 2417-2426. 

Capecitabine -converted to 5-FU preferentially by tumor cells pyrimidine analogue antimetabolite inhibits thymidylate synthase -mucocutaneous effects (stomatitis, mucositis) -diarrhea -bone marrow suppression -nausea and vomiting -palmar-plantar erythrodysethesias (hand-foot syndrome) -fatigue... 

Dacarbazine (DTIC) -atypical alkylating agent, noncell cycle dependent -bone marrow suppression -nausea and vomiting -vesicant if extravasated -flu-like syndrome -fever... 

Docetaxel -semisynthetic taxane stabilizes tubulin polymers leading to death of mitotic cells -bone marrow suppression -nausea and vomiting -mucocutaneous effects (mucositis, stomatitis, diarrhea) -hypersensitivity reactions -fluid retention syndrome -fatigue -myalgias -alopecia (universal)... 

Procarbazine -alkylating agent cell cycle independent -bone marrow suppression—prolonged -nausea and vomiting—severe tolerance often develops with repeated dosing -mucocutaneous effects (mucositis, stomatitis, diarrhea) -rash, hives, photosensitivity -interstitial pneumonitis -CNS toxicity—seizures, lethargy, headache, ataxia -flu-like syndrome -azoospermia and amenorrhea almost universal... 

The answer is c. (Hardman, pp 1134-1135.) Hematologic toxicity is by far the most important adverse effect of chloramphenicol The toxicity consists of two types (1) bone marrow depression (common) and (2) aplastic anemia (rare) Chloramphenicol can produce a potentially fatal toxic reaction, the gray baby syndrome, caused by diminished ability of neonates to conjugate chloramphenicol with resultant high serum concentrations. Tetracyclines produce staining of the teeth and phototoxicity... 

Krivit, W., Peters, C. and Shapiro, E. G. Bone marrow transplantation as effective treatment of central nervous system disease in globoid cell leukodystrophy, metachro-matic leukodystrophy, adrenoleukodystrophy, mannosidosis, fucosidosis, aspartylglucosaminuria, Hurler, Maroteaux-Lamy, and Sly syndromes, and Gaucher disease type III. Curr. Opin. Neurol. 12 167-176,1999. 

Gy Hematopoietic syndrome characterized by bone marrow damage, anemia, lowered immune response, hemorrhage, and sometimes death 20... 

Amphotericin B is the drug of choice for treatment of acute C. neoformans meningitis. Amphotericin B, 0.5 to 1 mg/kg/day, combined with flucytosine, 100 mg/kg/day, is more effective than amphotericin alone. In the acquired immune deficiency syndrome (AIDS) population, flucytosine is often poorly tolerated, causing bone marrow suppression and GI distress. 

Leukemia, lymphoma, Hodgkin s disease, or multiple myeloma / Generalized malignancy / Chronic renal failure of nephritic syndrome / Patients receiving immunosuppressive therapy / Organ or bone marrow transplant recipients... 

Neutropenias may also arise as a side effect or deliberate consequence of therapy. For example, some drugs used in the treatment of inflammatory disorders are immunosuppressive, and if these decrease the number of circulating neutrophils to below the critical threshold level, then susceptibility to infection may result. During chemotherapy for the treatment of solid tumours, an inevitable consequence of cytotoxic therapy is that the bone marrow will be destroyed by the drugs thus, patients will have a considerable risk of infection during this induction period. Similarly, during the treatment of haematological disorders (e.g. leukemias and myelodysplastic syndromes), the aim of therapy is to attack the bone marrow so as to destroy... 

The blood is made up of a liquid portion called the plasma and a solid portion which in turn comprises both red cells and white cells. The red cells, which are formed in the bone marrow and then passed into the blood stream, contain a chemical called hemoglobin that has the capacity to carry oxygen to the body tissues and carbon dioxide away from the body tissues. The white cells are involved in maintaining immunity to infection and in fighting disease. It is the interference by a virus with the immume process of the white cells that give rise to what we know as AIDS (auto immune deficiency syndrome). This condition, however, does not occur from exposure to chemicals. 

SCIDGeneTherapy Trial Infantswithsevere combined immunodeficiency disease (SCID, bubble boy syndrome) have a gene defect that leads to a complete lack of white blood cells. Without treatment, these infants die from comphcations of infectious diseases during the first few years of life. The only treatment currently approved for this condition is a bone marrow transplant. 

Baud 0, Goulet O, Canioni D, et al Treatment of the immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX) by allogeneic bone marrow transplantation. N Engl J Med 2001 344 1758-1762. 

Rao A, Kamani N, Filipovich A, et al Successful bone marrow transplantation for IPEX syndrome after reduced-intensity conditioning. Blood 2007 109 383-385. 

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