The development of the acquired immunodeficiency syndrome after bone-marrow transplantation.

Since bone-marrow transplant recipients receive considerable quantities of packed-cell, platelet and sometimes leukocyte transfusions, as well as the donor marrow infusion, it would be predictable that acquired immunodeficiency syndrome (AIDS) by blood-product transfusion would occur in this patient population. We report here two patients who received HLA-identical sibling bone-marrow transplants for acute non-lymphoblastic leukaemia during their first remission. Both developed category-A AIDS at days 342 and 546 after transplantation, respectively. Neither patient belonged to any known high-risk group for AIDS, other than having received a blood-product transfusion. One of the two patients is now known to have received blood from a donor who was human immunodeficiency virus (HIV) seropositive. Both patients developed Pneumocystis carinii pneumonia and other opportunistic infections, and both have died of AIDS without evidence of recurrence of their leukaemia. One patient had no chronic graft-versus-host disease (GVHD) and the other had mild chronic GVHD of the mouth. Since severe opportunistic infections are rare after transplantation in the absence of GVHD, their late occurrence after transplantation should raise the suspicion of AIDS. This complication is likely to have an adverse impact on the long-term survival of patients who received bone-marrow transplants between 1981 and the introduction of effective screening tests for HIV infection in blood donors.