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Immunoglobulin G subclass deficiency and pneumococcal infection after
allogeneic bone marrow transplantation
JF Sheridan, PJ Tutschka, DD Sedmak and EA Copelan
Department of Internal Medicine, Ohio State University College of Medicine,
Columbus 43210.
Serum immunoglobulin (Ig) G subclass levels were measured in a radial
immunodiffusion assay in 25 leukemic patients before and after allogenic
bone marrow transplantation. All patients received a conditioning regimen
of busulfan and cyclophosphamide followed by infusion of marrow from an
HLA-identical sibling. Intravenous infusions of a commercial Ig preparation
were administered every 2 weeks until day 120 posttransplant. Nine patients
developed pneumococcal infections at 6 months or greater posttransplant.
Infection was associated with low levels or the absence of detectable serum
IgG2 and IgG4. At the time of infection, 4 of 7 patients evaluated had
undetectable IgG2, while 5 of 7 had undetectable levels of IgG4. After
infection, none of the 8 patients evaluated had detectable levels of IgG2,
and only 2 of 8 had detectable levels of IgG4. In contrast, all 16 patients
without pneumococcal infection had IgG2 levels of 102 mg/dL or greater, and
IgG4 levels of 20 mg/dL or greater. It appears that IgG2 and IgG4 subclass
deficiencies after allogenic bone marrow transplantation contribute to
susceptibility to pneumococcal infection. After pneumococcal infection,
IgG2 and IgG4 levels remain low for a prolonged period and patients remain
susceptible to infection by encapsulated organisms.
Volume 75,
Issue 7,
pp. 1583-1586,
04/01/1990
Copyright © 1990 by The American Society of Hematology
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