PROLONGED SELECTIVE NEUTROPENIA AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION - POSSIBLE EFFECT OF PRESENSITIZATION BY DONOR LYMPHOCYTES PRIOR TO TRANSPLANT

Selective neutropenia lasting over five months occurred in a 17-year-o ld adolescent male who received an allogeneic bone marrow transplantat ion (BMT) from an HLA-identical sibling for severe aplastic anemia. Bo ne marrow specimens showed maturation arrest of myeloid precursor cell s despite sustained engraftment. Cytogenetic analyses revealed complet e donor-type chimerism in hematopoietic cells and mixed lymphoid chime rism. The patient received a second BMT from the same donor following more intensive conditioning, including total body irradiation. Neutrop hil recovery was rapid and complete donor-type hematopoietic and lymph oid chimerism was observed within three weeks of the second transplant . The present case suggests that prolonged selective neutropenia follo wing BMT is due to residual host-derived immunity which is resistant t o the standard immunosuppressive conditioning used prior to BMT for ap lastic anemia. (C) 1997 Elsevier Science Ireland Ltd.