HLA NONIDENTICAL T-CELL-DEPLETED BONE-MARROW TRANSPLANTATION FOR PRIMARY IMMUNODEFICIENCY DISEASES

Background: Bone marrow transplantation (BMT) is usually the only proc edure offering cure for children with life-threatening immune deficien cy disorders, but compatible sibling donors are frequently unavailable . Aims and Methods: To examine the outcome of HLA non-identical T-cell -depleted BMT carried out between April 1985 and May 1992 in 11 patien ts with primary immunodeficiency diseases and to seek prognostic facto rs. Results: Eight patients achieved sustained engraftment, one after a second BMT. One further patient engrafted transiently, but rejected the graft five months later. Acute graft-versus-host disease (GVHD) gr ade II was seen in one and chronic GVHD was seen in three children. Se ven patients survived beyond six months, six with donor T cell and fiv e with donor B cell engraftment. At present, five patients (46%) are a live with immune reconstitution at a median follow-up of 14 months (ra nge 6 to 78 months). The major factor associated with outcome was the presence of any infection within one week of BMT (p = 0.01). The prese nce of lung infection also tended to be a poor prognostic factor (p = 0.06) but did not reach significance, presumably because of the small sample size. HLA non-identical (parental) T-cell depleted BMT plays an important role in the cure of children with immunodeficiencies who do not have an identical sibling donor. Survival can be further improved if the diagnosis of immunodeficiency disease is made early and BMT un dertaken before significant infections occur. Conclusions: The availab ility of T-cell depleted haploidentical parental bone marrow transplan t can be anticipated to improve outcome significantly for children wit h severe immunodeficiency, especially when diagnosed early.