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Immunoglobulin levels and monoclonal gammopathies in children after bone
marrow transplantation
EJ Gerritsen, MJ van Tol, AC Lankester, CP van der Weijden-Ragas, CM Jol-van der Zijde, NJ Oudeman-Gruber, J Radl and JM Vossen
Department of Pediatrics, University Hospital, Leiden, The Netherlands.
Bone marrow graft recipients suffer profound immunodeficiency during at
least 3 months after transplantation. B-cell reconstitution following
allogeneic bone marrow transplantation (BMT) in children was studied
longitudinally by quantification of Ig (sub)class levels in serum and by
investigation of numbers and characteristics of homogeneous Ig components
(H-Ig); ie, monoclonal gammopathies (MG). For the latter purpose, a
sensitive immunoblotting technique capable of detecting H-Ig of a
concentration as low as 0.5 microgram/mL was used. Sera of 40 children
grafted for a variety of diseases were investigated and followed up for 5
years. It was found that Ig (sub)classes reached normal levels from 3
months after BMT onward. The sequential increase of the different Ig
isotypes was in accordance with that seen in normal ontogeny. This was
especially clear following BMT for severe congenital immunodeficiency. H-Ig
appeared from as early as 6 weeks after BMT in increasing numbers,
beginning within IgM, IgG3, and IgG1, and afterward within other isotypes.
After an initial increase of serum Ig levels, "overshooting" occurred
accompanied by high frequency of H-Ig. H-Ig were still present at 5 years
after BMT, when Ig levels normalized. Our data indicate that B-cell
reconstitution after allogeneic BMT recapitulates normal ontogeny but in a
clonally dysregulated fashion; that is, with overexpression of some clones
and underexpression of others.
Volume 82,
Issue 11,
pp. 3493-3502,
12/01/1993
Copyright © 1993 by The American Society of Hematology
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