Pneumocystis prophylaxis after bone marrow transplantation for severe aplastic anaemia.
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Biomedical subjects
Publications and source records attributed to A Bashey.
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The ability of 150 normal and pathological sera to opsonize yeast for uptake by isolated human polymorphonuclear leucocytes has been studied. Phagocytosis was measured by an assay depending on electronic particle counting to measure yeast uptake and by a new fluorometric assay which is able to distinguish particle adherence from true phagocytosis. The opsonic activity of normal human serum was heat labile and depended markedly on C3 levels. The sera of 6% of healthy young adults (three from 45) and 8% of healthy donors aged 65-88 (four from 57) showed defective opsonization in spite of normal C3 and CH50 levels. Thirty-eight pathological sera with low C3 levels showed defective opsonization. However, three sera with low C3 levels showed apparently normal opsonic activity. The opsonin from two of these sera was characterized. It was heat stable, had apparent mol.wt of 400,000 and was active in serum free media. The opsonin was absorbed by immobilized Staphylococcus aureus and by gelatin-Sepharose, suggesting that it is related to fibronectin. Fibronectin from normal human sera prepared by affinity chromatography on gelatin-Sepharose was not opsonic in this system.
Two patients with chronic myeloid leukemia (CML) who relapsed in blastic transformation after allogeneic bone marrow transplantation (BMT) were treated with infusions of leukapheresed peripheral blood mononuclear cells from their original donor. At relapse, their disease was characterized by symptomatic extramedullary deposits of leukemia with minimal (PCR positive, cytologically negative) involvement of bone marrow. Treatment with donor cell infusions was associated with clinical remission, return of full donor chimerism and loss of the BCR-ABL transcript detectable in bone marrow before donor leukocyte infusion (molecular remission). Donor leukocyte infusions should be considered for therapy of relapsed blastic phase CML after allogeneic BMT, especially when the relapse is primarily extramedullary and responsive to local and systemic cytoreductive therapy. However, severe GVHD and CNS relapse remain obstacles to achieving a successful long-term outcome.
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