Successful use of multiagent immunosuppression in the bone marrow transplantation of sensitized patients.
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.
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy*; D000920:Antibody-Dependent Cell Cytotoxicity; D000961:Antilymphocyte Serum / Q000494:pharmacology; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D003602:Cytotoxicity, Immunologic; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007111:Immunity, Cellular; D007165:Immunosuppression Therapy; D008285:Major Histocompatibility Complex; D008297:Male; D014184:Transplantation, Homologous
D000961:Antilymphocyte Serum