Long-term remission from acute myelogenous leukemia after bone marrow
transplantation and recovery from acute graft-versus-host reaction and
prolonged immunoincompetence
WA Bleyer, RM Blaese, JS Bujak, GP Herzig and RG Graw
A 19-yr-old boy has been in continuous complete remission from acute
myelogenous leukemia for 3 yr after allogeneic bone marrow transplantation
prepared with combination chemotherapy. During the first year
post-transplant, however, the patient developed near-fatal
graft-versus-host reaction followed by 11 severe viral and bacterial
infections. Immune evaluation during this period revealed multiple defects
which were not present prior to transplantation, nor present in the
transplant donor: diminution of lymphoid tissue, decline of all
immunoglobulin subtypes, deletion of secretory immunoglobulin,
disappearance of isohemagglutinins, loss of antibody to diptheria and
tetanus toxoids, cessation of cutaneous hypersensitivity to mumps antigen,
and inhibition of serum opsonizing activity. The patient was also unable to
develop normal humoral or cellular reactivity to brucella antigen, keyhole
limpet hemocyanin, or dinitrochlorobenzene. This patient's course
illustrates the severity and chronicity of immunoincompetence associated
with allogeneic marrow grafting, the importance of early detection and
rigorous treatment of infectious disease in these patients, and the need
for improved immunologic reconstitution in human marrow transplantation. It
also indicates that complete recovery from the immune defects is possible,
and that long- term remission from acute myelogenous leukemia can be
achieved with allogeneic marrow transplantation.
Volume 45,
Issue 2,
pp. 171-181,
02/01/1975
Copyright © 1975 by The American Society of Hematology
