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Increased serum levels of tumor necrosis factor alpha precede major
complications of bone marrow transplantation [see comments]
E Holler, HJ Kolb, A Moller, J Kempeni, S Liesenfeld, H Pechumer, W Lehmacher, G Ruckdeschel, B Gleixner and C Riedner
Medizinische Klinik III, Universitat Munchen, FRG.
Acute graft-versus-host disease, interstitial pneumonitis, endothelial
leakage syndrome, and veno-occlusive disease are major complications of
bone marrow transplantation. Though several new regimens for prophylaxis
and treatment of these syndromes have been introduced, the overall
incidence has been only slightly reduced over the last few years. We
retrospectively analyzed tumor necrosis factor alpha (TNF alpha) serum
levels between day -8 and day 100 after bone marrow transplantation in 56
patients transplanted in our unit for a variety of hematological diseases.
In 34 patients with uneventful courses, mean TNF alpha levels rose to a
maximum of 76 +/- 29 pg/mL. In contrast, 22 patients with major transplant
related complications showed mean increases of TNF alpha of 492 +/- 235
pg/mL (P less than .0001). Increases of TNF alpha occurred before
interstitial pneumonitis and severe acute graft-versus-host disease with a
latency of 25 to 54 days. Early complications such as endothelial leakage
syndrome and veno- occlusive disease were closely associated with increases
of TNF alpha serum levels. Our study suggests two pathways of TNF alpha
release: activation of host macrophages and stimulation of donor cells in
the course of acute graft-versus-host disease. Cytokine monitoring should
be helpful for prediction and earlier treatment of major transplant related
complications.
Volume 75,
Issue 4,
pp. 1011-1016,
02/15/1990
Copyright © 1990 by The American Society of Hematology
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