Transplant of rhesus-positive bone marrow in a rhesus-negative woman having anti-rhesus D alloantibodies.
A woman affected by acute myeloblastic leukemia was grafted with HLA A, B and D compatible rhesus-positive bone marrow from her brother. Before grafting, she had anti-D alloantibodies (1/512 IAT, 2.9 micrograms/ml). To prevent the destruction of donor red blood cells, four plasma exchanges and a conditioning regimen (total-body irradiation 800 rad, cyclophosphamide, methotrexate) were carried out to decrease anti-D from 2.9 to less than 0.02 micrograms/ml on day 0. The anti-D level was 0.8 micrograms/ml on day 12 and was decreased to 0.2 micrograms/ml by eight plasma exchanges until day 35. Anti-D antibodies were undetectable with Lalezari's technique on day 45. Engraftment was obtained on day 25 (3,000 leukocytes/mm3 and 50% erythroblasts in bone marrow). The patient died from aspergillosis and graft-versus-host disease on day 54. This observation shows that an engraftment of rhesus-positive bone marrow in a recipient with anti-D antibody is possible.
D000328:Adult; D001853:Bone Marrow / Q000276:immunology; D016026:Bone Marrow Transplantation; D003298:Coombs Test; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007518:Isoantibodies / Q000032:analysis / Q000276:immunology*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008727:Methotrexate / Q000627:therapeutic use; D010951:Plasma Exchange; D012204:Rh-Hr Blood-Group System / Q000276:immunology*; D014181:Transplantation Immunology; D014916:Whole-Body Irradiation
D007518:Isoantibodies; D012204:Rh-Hr Blood-Group System; D003520:Cyclophosphamide; D008727:Methotrexate