Immunocompetence following allogeneic bone marrow transplantation in man.

Abstract

The immune competence of four patients with acute lymphocytic leukemia who were engrafted with bone marrow from their HL-A-matched, mixed leukocyte culture-compatible siblings was assayed during the pre- and post-transplant period. Two patients who did not develop graft-versus-host-reaction (GVHR) demonstrated depression of their lymphocyte response to phytohemagglutinin (PHA) in vitro. In these patients an intact efferent arm of the delayed hypersensitivity reaction was demonstrated post-transplant by positive skin test reactions to multiple antigens. Reactivity to at least one of the antigens in both patients was transferred from the bone marrow donor. Humoral immune capacity was documented in both patients by the production of antibody following primary immunization and to viral infections. The third patient had moderately severe GVHR. This patient had intact humoral immune function but was anergic to 1-chloro- 2,4-dinitrobenzene (DNCB) and skin test antigens. His lymphocytes responded poorly to PHA in vitro. This patient also developed and survived a viral infection. The fourth patient who died of GVHR with concurrent infection failed to demonstrate humoral or cellular immune reactivity in the post-transplant period. It is concluded that these human allogeneic bone marrow chimeras show more marked depression of cellular than of humoral function. The depression of total immune function appeared to correlate with the severity of the GVHR.