A 20‐yr‐old man with bulky mediastinal and retroperitoneal tumour masses identified as myeloblastoma is described. After a partial remission was induced by aggressive chemotherapy, mediastinal irradiation and retroperitoneal tumour resection, the patient received an allogeneic marrow graft from his HLA‐identical sister. The conditioning regimen consisted of high‐dose busulfan and cyclophosphamide. The patient has a well‐controlled secondary chronic graft‐versus‐host disease. He is in unmaintained complete remission and in good general condition at 20 months post‐transplantation.
Transfer of immunity occurring with bone marrow grafting was studied using the dog as a preclinical model. Allogeneic bone marrow transplantation (BMT) was performed between DLA-identical beagle littermates. The donors were immunized with tetanus toxoid (TT) or sheep red blood cells (SRBC), and their humoral response was monitored by hemagglutination. The recipients of bone marrow from TT-immunized donors showed a marked increase of antibody titer one week posttransplantation, while in the recipients of marrow from SRBC immunized donors the antibody titers were considerably lower. Within the following 60 days the antibody titers in both groups diminished gradually to pregrafting levels. Control experiments in which cellfree plasma from donors immunized with TT and SRBC respectively was transfused indicated that the initial rise of specific antibody tites after marrow grafting is likely to be due to a passive transfer of humoral, immunity. A single challenge of these marrow graft recipients with the respective antigen 15–18 weeks posttransplantation led to a secondary type of humoral immune response. In addition, it could be demonstrated that transfer of memory against TT or SRBC was independen from the actual antibody titer and the time of vaccination of the donor. One dog was immunized with TT after serving as marrow donor. When the donor had shown an antibody response, a peripheral blood leukocytes (PBL) transfusion was given to his chimera. Subsequent challenge of the latter resulted in a secondary type of specific antibody response. This indicates that specific cellular-bound immunological memory can be transferred after BMT from the donor to his allogneneic bone marrow chimera by transfusion of peripheral blood leukocytes. The data presented may be of importance in clinical BMT to protect patients during the phase of reduced immune reactivity by trnsfer of memory cells from histocompatible immunized donors.
Mit Hilfe der Knochenmark-Transplantation ist es möglich geworden, eine Bluterkrankung wie die akute Leukämie zu heilen. Kommt es zu einer Transplantat-gegen-Wirt-Reaktion, so entstehen bei chronischem Verlauf am Auge typische Veränderungen der Bindehaut, wie sie vom Sjögren-Syndrom und vom Schleimhaut-Pemphigoid bekannt sind. Kasuistisch werden diese ophthalmologischen Komplikationen beschrieben und im Sinne einer Immunreaktion diskutiert.