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Immunologic reconstitution after haploidentical bone marrow transplantation
for immune deficiency disorders: treatment of bone marrow cells with
monoclonal antibody CT-2 and complement
RC Moen, SD Horowitz, PM Sondel, WR Borcherding, ME Trigg, R Billing and R Hong
Patients with congenital T lymphocyte deficiency disorders received
transplants with parental bone marrow depleted of mature T cells by the use
of an anti-T cell monoclonal antibody (CT-2) and complement. Our results
with 16 consecutive patients (20 transplants) showed rapid engraftment of
donor cells; cytoreduction (busulfan, cytosine arabinoside [ara-C],
cyclophosphamide) was used in six transplants, and marrow ablation was used
in six (ara-C, cyclophosphamide, 1,365-cGy total body irradiation). No
patient received prophylactic anti-graft-v- host disease (GVHD) therapy
posttransplant, and only one patient developed significant GVHD, which
involved the skin, liver, and gastrointestinal tract. Seven others showed
some manifestations of GVHD, but these were of minimal clinical
significance and required only occasional steroid therapy. Overall, eight
patients are alive and well; eight did not survive. Polyclonal
immunoglobulin synthesis by donor memory B cells was seen shortly after
transplantation, with peak donor- derived serum levels seen approximately 2
months after transplantation. After this initial immunoglobulin synthesis
waned, another wave of B cell responses developed. This immunoglobulin
response appears to be permanent. T cell functions appeared as soon as 3
weeks after transplantation. This experience in a variety of patients with
combined immunodeficiency who received transplants with monoclonal antibody
T cell-depleted marrow shows gratifying results with a consistent T and B
cell benefit.
Volume 70,
Issue 3,
pp. 664-669,
09/01/1987
Copyright © 1987 by The American Society of Hematology
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