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[Hematopoietic cell transplantation in X-linked adrenoleukodystrophy].
[adrenomyeloneuropathy]
X-
linked
adrenoluekodystrophy
(
X-
ALD
)
is
a
clinically
heterogenous
disorder
ranging
from
the
rapidly
progressive
childhood
cerebral
form
to
the
milder
adrenomyeloneuropathy
in
adults
,
and
some
persons
with
ALD
protein
(
ALDP
)
defects
may
remain
asymptomatic
for
life
.
Hematopoietic
cell
transplantation
(
HCT
)
is
currently
the
only
effective
therapy
for
cerebral
X-
ALD
.
Stem
cell
sources
for
transplantation
are
bone
marrow
,
peripheral
blood
and
cord
blood
.
The
donor
should
be
HLA
identical
with
the
recipient
and
can
be
found
within
family
members
or
from
unrelated
bone
marrow
or
cord
blood
donor
pools
.
Preparative
conditioning
with
supralethal
chemoradiotherapy
is
needed
for
donor
cell
engraftment
,
and
immunosuppressive
agents
are
given
for
months
as
prophylaxis
against
graft-verus-host
disease
(
GVHD
)
.
Worldwide
data
collection
reported
56
%
of
long
term
survival
.
Neurologic
and
MRI
severity
at
the
time
of
transplantation
was
the
most
important
factor
for
survival
and
the
degree
of
improvement
after
transplantation
.
More
than
90
%
of
early
stage
patients
have
survived
with
good
quality
of
life
for
a
long
term
,
whereas
patients
with
advanced
disease
had
the
higher
mortality
rate
during
transplant
procedures
and
the
neurological
abnormalities
progressed
in
most
of
them
.
Patients
with
a
parietal
-
occipital
lobe
pattern
of
demyelination
demonstrated
a
greater
mean
loss
of
performance
IQ
(
PIQ
)
points
than
patients
with
a
frontal
lobe
pattern
of
demyelination
.
Thus
,
boys
with
early
-
stage
disease
benefit
from
HCT
,
whereas
boys
with
advanced
disease
may
be
candidates
for
experimental
therapies
.
Diseases
Validation
Diseases presenting
"long term"
symptom
adrenomyeloneuropathy
allergic bronchopulmonary aspergillosis
canavan disease
child syndrome
congenital diaphragmatic hernia
congenital toxoplasmosis
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
fabry disease
hirschsprung disease
hydrocephalus with stenosis of the aqueduct of sylvius
kindler syndrome
megacystis-microcolon-intestinal hypoperistalsis syndrome
oculocutaneous albinism
oligodontia
werner syndrome
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