Gorin N C, Muller J Y, Salmon C, Fine J M, Rouger P, Fortier B, Petit J C, Girard O, Leblanc G, David R, Stachowiak J, Parlier Y, Najman A, Duhamel G
Nouv Presse Med. 1980 May 10;9(21):1485-9.
Following transplant, circulating immunoglobulin levels fell moderately and remained depressed less than 2 months for IgG, and for variable and longer periods of time for IgM and IgA. Repeated quantitative determinations of antibodies against multiple antigens did not show any decrease in the pretransplant levels. Indeed some patients developed herpes and cytomegalovirus infections to which they responded by a sharp increase in antibody titers. In 2 cases, a primary immunization was demonstrated (against CMV and BK virus) with increasing levels of IgM and IgG antibodies. Lymphocyte counts in peripheral blood returned to 500 mm# between day 10 and 29 (median day 18) and to pretransplant values within 6 weeks. Non specific stimulation of lymphocytes by mitogens in the immediate post-transplant period showed a decreased response to PHA and Con A, whereas the responses to pokeweek mitogens and alloantigens were only slightly diminished. The degree of the responses was related to the dose of cryopreserved marrow infused. We conclude that:--although the minimum dose for autologous bone marrow transplantation in man is around 0,5 10(8) nucleated bone marrow cells/Kg, much higher doses should be used to ensure faster and better restoration of immune reactivity.--The similarity of the immunological dysfunction following autologous and allogeneous bone marrow transplantation suggest that, in the immediate post-transplant period, the role of GVHD in cellular immunity depression may be minimal.
移植后，循环免疫球蛋白水平适度下降，IgG水平低于2个月时仍处于较低水平，IgM和IgA水平下降的时间则可变且更长。针对多种抗原的抗体重复定量测定未显示移植前水平有任何下降。实际上，一些患者发生了疱疹和巨细胞病毒感染，他们通过抗体滴度急剧升高来应对。在2例患者中，证实有初次免疫（针对巨细胞病毒和BK病毒），IgM和IgG抗体水平升高。外周血淋巴细胞计数在第10天至29天（中位第18天）恢复到500/mm³，并在6周内恢复到移植前水平。移植后立即用丝裂原对淋巴细胞进行非特异性刺激显示，对PHA和Con A的反应降低，而对商陆丝裂原和同种异体抗原的反应仅略有减弱。反应程度与输注的冷冻保存骨髓剂量有关。我们得出结论：——尽管人类自体骨髓移植的最小剂量约为0.5×10⁸有核骨髓细胞/千克，但应使用更高剂量以确保免疫反应性更快、更好地恢复。——自体和异体骨髓移植后免疫功能障碍的相似性表明，在移植后即刻，移植物抗宿主病在细胞免疫抑制中的作用可能最小。
