AUTOLOGOUS MARROW RECOVERY FOLLOWING ALLOGENEIC MARROW TRANSPLANTATION IN A PATIENT WITH SEVERE APLASTIC-ANEMIA

Abstract

A 45 yr old woman with severe idiopathic marrow failure was prepared for marrow transplantation by administration of cyclophosphamide (cy) 50 mg/kg on each of 4 successive days. She then received an i.v. infusion of 20 .times. 109 nucleated marrow cells from an HL-A [histocompatibility antigen] matched and mixed lymphocyte culture (MLC) non-reactive sister. There was evidence for minimal marrow recovery in 1-2 mo. and a 2nd marrow infusion was carried out 69 days after the 1st without additional immunosuppression. There was a continued slow recovery of peripheral blood counts with complete reconstitution of erythropoiesis, return of the white blood cell count to between 3 and 4000/mm3, with 50% granulocytes, and platelets to 60-70,000/mm3, 11 mo. after the initial grafting attempt. Red cell antigens and .gamma. globulin allotypes were of recipient type. The MLC and the indirect cell mediated lympholysis (CML) test became positive, possibly indicating cellular sensitization to non HL-A antigens. This report of a patient with severe marrow failure documents autologous recovery of marrow function after receiving a large dose of cy and allogeneic marrow. The implications of this are discussed.