INVITRO REGULATION OF IMMUNOGLOBULIN-SYNTHESIS AFTER MARROW TRANSPLANTATION .1. T-CELL AND B-CELL DEFICIENCIES IN PATIENTS WITH AND WITHOUT CHRONIC GRAFT VERSUS HOST-DISEASE

Abstract

Patients (24) with aplastic anemia or acute leukemia were treated by marrow grafts from HLA-identical donors after conditioning with high doses of cyclophosphamide and/or total body irradiation. They were studied of 4-63 mo. (median 14.2) after transplantation. Seventeen patients had chronic graft-vs.-host disease (C-GVHD); 7 were healthy. They were studied for defects in their T and B cell function using an indirect hemolytic plaque assay for Ig production after 6 days of culture in the presence of pokeweed mitogen. T or B cells from the patients with or without C-GVHD were cocultured with T or B cells from their HLA-identical marrow donors or unrelated normal controls. Intrinsic B cell defects, lack of helper T cell activity and suppressor T cell activity were more frequently found in patients with C-GVHD than in healthy patients. Of the 17 patients with C-GVHD, 15 showed 1 or more defects in their T and B cell function compared to only 3 of the 7 patients without C-GVHD. None of the healthy controls, including the marrow donors, showed defects in their T and B cell functions. These in vitro findings may be helpful in assessing the process of immune reconstitution and the immunologic aberrations found after human marrow transplantation.