Blood, 15 April 2002, Vol. 99, No. 8, pp. 3070-3070
CORRESPONDENCE
To the editor:
Measles in bone marrow transplant recipients
Machado et al1 should be congratulated on seizing
the opportunity of the 1997 measles outbreak in São Paulo,
Brazil, for learning about measles in marrow transplant recipients. Per
the report, only 8 of 156 patients (5.1%) developed measles, and only 1 patient (0.6%) had a severe disease (measles pneumonia). But both
the incidence and the severity of measles were likely underestimated. Measles was defined by seroconversion (appearance or 4-fold rise of
specific antibodies). A significant fraction of transplant recipients
cannot seroconvert (reviewed in Storek and Witherspoon2 and in Parkman and Weinberg3). In the São Paulo
study, patients with symptoms or signs of measles who did not
seroconvert were considered to be patients without measles. The
immunity of the patients who could not seroconvert was probably more
compromised than the immunity of the patients who could seroconvert.
Therefore, the incidence of measles in the patients who could not
seroconvert may have been high and the course of the disease in these
patients may have been severe. Thus, substantially more than 5.1%
transplant recipients may develop measles during an outbreak, and
substantially more than 0.6% patients may have a severe course.
Jan Storek
Correspondence: Jan Storek, Fred Hutchinson Cancer Research
Center, D1-100, 1100 Fairview Avenue N, Seattle, WA 98109-1024; e-mail:
jstorek{at}fhcrc.org
References
1.
Machado CM, Goncalves FB, Pannuti CS, Dulley FL, de Souza VA.
Measles in bone marrow transplant recipients during an outbreak in São Paulo, Brazil.
Blood.
2002;99:83-87[Abstract/Free Full Text].
2.
Storek J, Witherspoon RP.
Immunologic reconstitution after hematopoietic stem cell transplantation. In:
Atkinson K, ed.
Clinical Bone Marrow and Blood Stem Cell Transplantation. Cambridge United Kingdom: Cambridge University Press; 2000:111-146.
3.
Parkman R, Weinberg KI.
Immunological reconstitution following hematopoietic stem cell transplantation. In:
Thomas ED,Blume KG,Forman SJ, eds.
Hematopoietic Cell Transplantation. Malden, MA: Blackwell Science; 1999:704-711.
