Bone marrow transplantation in combined immunodeficiencies.

Correction of combined immunodeficiences was attempted in 4 patients. Attainment of lasting immunologic reconstitution was restricted to an HL-A identical graft. However, HL-A identity was not a safeguard against graft-vs-host reaction (GVHR). Failure of donor-host adaptation resulted in chronic GVHR. In unmatched grafts, alloimmune plasma was capable of only transient amelioration of GVHR. Alloimmune plasma prevented fatal GVHR in one patient receiving a HL-A semiidentical graft. However, no direct evidence for a T-cell engraftment was shown. The failure to prevent GVHR or to reverse an ongoing reaction in incompatible bone marrow transplantations demands a reappraisal of the conceptual approach to immunologic tolerance.