SALIVARY IMMUNOGLOBULINS IN RECIPIENTS OF BONE-MARROW GRAFTS .1. A LONGITUDINAL FOLLOW-UP

Patients receiving bone marrow transplantation (BMT) are prone to a va riety of bacterial, viral and fungal infections in their oral cavity, We have therefore followed alterations in salivary Ig levels associate d with BMT, Most of the patients were transplanted with allogeneic, MH C-matched BM after T cells were depleted by ex vivo treatment with an anti-lymphocytic monoclonal antibody (Campath-1) and autologous comple ment, Parotid saliva was collected at various time intervals before an d after BMT, and IgM, IgG and IgA concentrations were determined by an enzyme linked immunosorbent assay (ELISA). A gradual fall in Ig level s was detected following patient's conditioning with a combination of chemo- and radiation therapy beginning 10 days prior to BMT, A rise in the titer of salivary Ig could be detected as early as 4 days post-BM T, which increased continuously and reached plateau levels within 2-3 weeks, However, about 3 weeks later the Ig titers decreased again and persisted at low levels for variable periods of time, A second increas e in salivary Ig was detected approximately 2 months post-BMT, which p ersisted for prolonged periods of time, These results suggest that Ig secreted by donor B-lymphocytes and plasma cells passively transferred with the BM can rapidly reconstitute the salivary IgM, IgG and IgA of the immunocompromised recipient, However, when these cells cease to p roduce Ig the patients are still immunoincompetent and therefore enter a second phase of salivary Ig deficiency which may render them highly susceptible to opportunistic oral infections, A second and persistent increase in salivary Ig levels appears several months post-BMT, along with the overall reconstitution of hemopoiesis in the patient,