Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
BONE MARROW TRANSPLANTATION FOR CONGENITAL AND ACQUIRED IMMUNODEFICIENCY SYNDROMES
UCLA Symp Mol Cell Biol; New Ser 91:337-44 1989. Unique Identifier : AIDSLINE ICDB/90657469 Weinberg K; Lenarsky C; Kohn D; Parkman R; Dept. of Pediatrics, Univ. of Southern California Sch. of; Medicine, Los Angeles, CA 90027
Abstract:
The present status of bone marrow transplantation (BMT) in the treatment of congenital immunodeficiency syndromes is summarized, and the possible role of BMT in treating acquired immunodeficiency syndromes is discussed. BMT has an established role in the treatment of patients (pts) with congenital immune deficiency syndromes (eg, severe combined immune deficiency, Wiskott-Aldrich syndrome, Chediak-Higashi syndrome, and X-linked proliferative syndrome). At present there is no established role for the use of allogeneic BMT in the treatment of pts with primary abnormalities of B-lymphocyte function. Although the use of histocompatible BMT has an established role in the treatment of congenital immunodeficiency syndromes, the use of haploidentical or histoincompatible BMT to treat immunodeficiency states is limited. There has been limited clinical experience with BMT for acquired immune deficiency syndromes secondary to infection with HIV or Epstein-Barr virus. Initial attempts to treat pts with acquired immune deficiency syndrome by BMT used human leukocyte group A-identical donors with no pretransplant chemotherapy. There were no improvements in the pts' clinical conditions or immune functions. Other efforts have employed identical twin donors to reduce the problems associated with graft-vs-host disease. In most cases, the pts did not receive pretransplant chemotherapy nor were antiviral agents given before or after transplantation. No assessments of the pts' HIV status were made following transplantation, and no significant improvements in the pts' immune status were demonstrated. Optimal conditions for the use of BMT to treat HIV-infected pts which may improve the clinical success include the following: (1) the use of donors genetically dissimilar from the pt; (2) treatment before significant opportunistic infections develop; (3) reduction of HIV burden prior to transplantation; (4) the use of anti-HIV agents during the pre- and post-transplant period; and (5) introduction and expression of anti-sense for HIV in the transplanted stem cells in the hopes of obtaining cells resistant to HIV infection/replication. (11 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*THERAPY Bone Marrow Transplantation Graft vs Host Disease/PREVENTION & CONTROL Histocompatibility Testing Human Immunologic Deficiency Syndromes/CONGENITAL/*THERAPY Lymphocyte Depletion Prognosis T-Lymphocytes/IMMUNOLOGY MEETING PAPER REVIEW, TUTORIAL REVIEW 900130
M9010542
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
