Graft versus graft and graft versus host reactions after HLA‐identical bone marrow transplantation in a patient with severe combined immunodeficiency with transplacentally acquired lymphoid chimerism


Journal Article

We describe a patient with severe combined immunodeficiency and transplacental transfer of maternal T cells who received an unfractionated HLA‐identical sibling bone marrow transplant without prior conditioning. He presented prior to transplantation with a dermatitis later diagnosed as mild graft versus host disease. He had a normal absolute lymphocyte count, but proliferative responses to mitogens were very low. Antigens of the noninherited maternal HLA haplotype were detected on his blood lymphocytes. After transplantation, he developed a severe reaction including fever, cutaneous erythema and hepatosplenomegaly. Lymphocytes carrying the noninherited maternal HLA haplotype disappeared from his circulation, and his unprimed mononuclear cells became spontaneously cytotoxic to maternal lymphoblasts. He subsequently developed a lymphocytosis of 69,000/mm 3 , diarrhea, elevated transaminases and a worsening rash, necessitating treatment with immunosuppressive agents. Full T‐cell engraftment and evidence of B‐cell function later ensued and spontaneously cytotoxic lymphocytes against maternal cells disappeared by 47 days post‐transplantation. We postulate that the patient's constellation of signs and symptoms after transplantation represented a combination of severe graft versus graft and mild graft versus host reactions. Copyright © 1991, Wiley Blackwell. All rights reserved

Full Text

Duke Authors

Cited Authors

  • Friedman, NJ; Shiff, SE; Ward, FE; Schiff, RI; Buckley, RH

Published Date

  • January 1, 1991

Published In

Volume / Issue

  • 2 / 3

Start / End Page

  • 111 - 116

Electronic International Standard Serial Number (EISSN)

  • 1399-3038

International Standard Serial Number (ISSN)

  • 0905-6157

Digital Object Identifier (DOI)

  • 10.1111/j.1399-3038.1991.tb00192.x

Citation Source

  • Scopus