Transfusion of donor buffy coat cells in the treatment of persistent or recurrent malignancy after allogeneic bone marrow transplantation.

BACKGROUND: Patients who experience relapse after allogeneic bone marrow transplantation have a poor prognosis. However, preclinical and clinical data have strongly suggested the existence of an immune-mediated anti-tumor effect of allogeneic bone marrow transplantation. This effect, termed graft-versus-leukemia, may be harnessed purposefully in patients with posttransplant relapses by the administration of immune cells obtained by leukapheresis of the original bone marrow donor. STUDY DESIGN AND METHODS: Thirteen patients with persistent or recurrent hematologic malignancy after HLA-matched sibling-donor allogeneic bone marrow transplantation were treated with transfusion of buffy coat cells collected from the original bone marrow donors. Mononuclear cell dose ranged from 1.18 to 4.28 x 10(8) per kg. Alpha-interferon (1.5-3 x 10(6) U/m2 3-5x/week) was given to seven patients. Patients were observed for the development of graft-versus-host disease and disease response. RESULTS: Three of five patients with chronic myelogenous leukemia had complete remissions. One of five patients with active acute leukemia attained complete remission. A sixth acute leukemia patient treated with buffy coat transfusion after the induction of remission with chemotherapy relapsed 12 months later. One patient with myeloma had a complete but transient response. A patient with Hodgkin's disease did not respond. Four patients remain in remission 4, 16, 17, and 29 months after attaining complete remission. Graft-versus-host disease occurred in eight patients, including all of those with a complete response. One patient developed transient pancytopenia. CONCLUSION: The transfusion of donor buffy coat cells has significant anti-tumor activity in patients with relapsed hematologic malignancy after allogeneic bone marrow transplantation. This effect is strongly associated with graft-versus-host disease.

Tissue transplant-transmitted infections.

Tissue bankers, as well as those transplanting tissues, have been sensitized to the possibility of transmission of fatal infection via tissue transplants, particularly following recent reports of a few cases of AIDS or HIV infection from bone, semen, and skin grafts. It is beyond the scope of this review to describe the steps taken by tissue banks to enhance the safety of tissue transplants. Of note is the fact that a number of new donor screening tests, such as those for antibody to HIV, HBcAg, hepatitis C virus, and human T cell lymphotropic virus type I, have recently been implemented. In addition, rapid advances in the medical history screening of tissue donors and tissue procurement, processing, and preservation continue. Viral inactivation studies are also being undertaken. All these measures are being introduced to increase the safety of tissue transplants.

A new specificity, SH7 (Bw75), defined by antisera produced by planned immunization.

SH7 specificity was defined by a group of antisera developed in Shanghai, China by planned immunization. SH7 antibody is cross-reactive with B5 and B15, as demonstrated by the serological reaction patterns obtained during planned immunization. Using 9th and 10th International Histocompatibility Workshop sera, we were able to confirm SH7, TS-1 and B15Kemp as identical specificities. They are equivalent to BW62S and B15Short-Thai. In view of the cross-reaction patterns obtained during planned immunization, SH7 appears to belong to the B5, B15, B35 and Bw70 cross-reactive groups.

AIDS, ethics, and the blood supply. A report of a conference of the American Blood Commission and the Hastings Center, Institute of Society, Ethics and the Life Sciences, January 29 and 30, 1985.

Although the conference was not held to determine policy, certain issues emerged which should be of interest to all involved with the initiation of anti-HTLV-III testing. First, there was a consensus that an implementation period during which donors will not be notified of the test results is essential. During this period, test proficiency, data confidentiality safeguards, and positive donor counseling procedures can be established. Also, during this period alternative test sites can be established; this was considered a critical step to maintain the safety of the blood supply. Second, there was a perceived need for legislation to protect the confidentiality of sensitive test data, whether in the laboratory or as part of a deferral list system, from subpoena. Third, there was not agreement about whether inventory should be tested; donors who provided that inventory did not know it was to be tested, and might not have consented if the implications of testing had been known. But, inventory testing is clearly in the interest of the recipient. Finally, there was an awareness in the blood banking community of their new role in monitoring a public health menace, and a beginning acceptance of this role emerged.

Four crossmatch methods to select platelet donors.

We employed four crossmatch techniques to select platelet donors for refractory patients. Forty-four donor-recipient pairs were studied in 32 patients. Analysis of effectiveness of platelet transfusions revealed that only 18 percent of transfusions gave a borderline response; the remainder were either effective or not effective at all. The corrected predictive values of three crossmatch tests were as follows: enzyme-linked immuno-specific assay, 81 percent; platelet immunofluorescence test, 73 percent; and lymphocytotoxicity, 70 percent (p greater than 0.05). The predictive value of these tests did not differ in HLA-matched versus unmatched platelet transfusions. Donor selection by lymphocytotoxicity compatibility did not appear to be useful if donors were selected by either of the other two methods. The fourth test, antiglobulin-modified lymphocytotoxicity, offered no advantage over lymphocytotoxicity. Our data suggest that platelet crossmatching assays are a useful adjunct to the selection process for the platelet donor in addition to ABO, Rh, and HLA matching.

Positive direct antiglobulin test due to anti-Fra in a newborn infant.

A positive direct antiglobulin test due to anti-Fra was found in a newborn infant whose mother previously had borne two other Fr(a+) children; all three were clinically unaffected. Family studies showed no evidence for close linkage between the Fr and HLA loci.

Impact of the anticoagulant-preservative citrate-phosphate-adenine (CPDA-1) on blood services.

The introduction of CPDA-1, as opposed to CPD, has allowed blood banks to store red blood cells for up to 35 days. The Missouri-Illinois Regional Blood Services studied the impact of CPDA-1 in three areas: reduction in blood outdating, change in distribution pattern, and the potential increase in the age of the products transfused. Our eighteen month study showed a reduction in blood outdating from 7.9 per cent to 3.9 per cent. Additionally, each unit of blood was distributed less frequently (from an average of 1.21 to 1.08 times from collection to transfusion). At the same time there was only a small increase in the mean age of the products transfused. It is our conclusion that the benefits of CPDA-1 can be attained with limited impact on the age of the products transfused.

The distribution of serum alanine aminotransferase levels in a blood donor population.

The authors studied the distribution of alanine aminotransferase (ALT) levels in 10,034 volunteer blood donors. The mean +/- SD ALT value was 21.4 +/- 19.3 IU/liter; 549 (5.5%) of the donors had a ALT value greater that 45 IU; 2.5 per cent had ALT values greater than 60 IU. In general, ALT levels were higher in males than in females, and were age related; peak values occurred in the third decade of life for males and between 50-60 years of age in females. ALT values greater than 45 IU were found significantly more often in males, in donors of both sexes 30-40 years of age, in married donors, in non-Caucasians, and in those whose education level was no higher than high school. Follow-up samples in donors with an initial ALT greater than 45 IU, revealed that 67% continued to have ALT values above 45 IU 2-8 weeks following initial sampling, and 40% had an ALT greater than 45 IU when tested again six months after entry into the study. ALT values greater than 60 IU were associated with a significantly increased prevalence of antibody of hepatitis B surface antigen (anti-HBs) and antibody to hepatitis B core antigen (anti-HBc) occurring together. No statistically significant association was found between transaminase activity and the prevalence of anti-HBs or anti-HBc alone, or with hepatitis A antibody. These findings demonstrate that there are defined sociodemographic and serologic features of donors with elevated ALT values.