Successful use of multiagent immunosuppression in the bone marrow
transplantation of sensitized patients
R Parkman, J Rappeport, B Camitta, RH Levey and DG Nathan
Of 23 patients with severe aplastic anemia, 17 were sensitized to
histocompatibility antigens of HLA-A, -B, and -D loci-identical potential
sibling donors as determined by cell-mediated lysis (CML) assays in vitro.
Antibody-dependent sensitization was detected in 3 patients,
antibody-independent cellular sensitization in 11, and both in 3. Fourteen
sensitized patients were transplanted after initial multiagent
immunosuppression consisting of rabbit anti-human thymocyte serum,
procarbazine, and cyclophosphamide, eleven with a CML-positive donor and
three with a CML-negative donor. Engraftment was achieved in each of 13
patients who were evaluable, and only 2 ultimately rejected their marrow
grafts, 1 with subsequent return of his own marrow function. Five patients
without evidence in vitro of sensitization were transplanted after
immunosuppression with cyclophosphamide alone; none of these rejected their
grafts. These studies show that sensitized bone marrow transplant
recipients can be successfully transplanted after optimal donor selection
and multiagent immunosuppression.
Volume 52,
Issue 6,
pp. 1163-1169,
12/01/1978
Copyright © 1978 by The American Society of Hematology
