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STUDIES OF IMMUNOLOGICAL REACTIVITY FOLLOWING SYNGENEIC OR ALLOGENEIC MARROW GRAFTS IN MAN

This report describes studies of immunological reactivity in 13 marrow transplant recipients prepared for engraftment with 1,000 rads of total body irradiation, cyclophosphamide, or both, and observed for 5–30 months after engraftment. Three patients with hematological malignancy had identical twin donors; five patients with hematological malignancy and five with aplastic anemia had HL-A-matched sibling donors. Serum IgG, IgA, and IgM levels declined in all recipients and then returned to normal by day 100. Absolute lymphocyte counts were above 1,000/mm3 in all patients within 1–3 months after grafting. Two of the three twin recipients showed normal antibody responses to bacteriophage by days 39 and 365 postgrafting and cutaneous reactivity to dinitrochlorobenzene by days 393 and 678. These three patients had no significant infections. Allogeneic graft recipients showed a markedly decreased antibody response to bacteriophage. In contrast, several of these recipients developed cytomegalovirus or herpes zoster infections, from which they recovered, and they developed good antibody titers against these agents. Testing in mixed leukocyte culture showed that cells from recipients of syngeneic grafts displayed normal responses to allogeneic cells and phytohemagglutinin. Recipients of allogeneic grafts showed a wide range of responsiveness but clear stimulation was observed on nearly all occasions, even within the 1st month after grafting. Despite this in vitro reactivity, the allogeneic recipients, with one exception, could not be sensitized to dinitrochlorobenzene when tested between days 28 and 365. We conclude that recipients of syngeneic grafts show a satisfactory return of immunological reactivity. Recipients of allogeneic grafts show a long lasting immunological deficiency which points out the necessity for vigilance in early detection and treatment of infection and the need for additional measures to restore immunological competence in these patients.