USE OF GNOTOBIOTIC METHODS FOR A CHILD WITH SEVERE COMBINED IMMUNODEFICIENCY(SCID) TRANSPLANTED WITH MARROW FROM AN UNRELATED MIXED LYMPHOCYTE CULTURE (MLC) COMPATIBLE DONOR

Abstract

A male infant in a family with the autosomal form of SCID was delivered vaginally. SCID was diagnosed on cord blood and later confirmed. He was kept free of infection by reverse isolation in a laminar flow hood from age 1 week until transplant 5 months later. Before transplant, decontamination was begun with chlorhexidine for the skin and oral cephaloridine, neomycin and mycostatin for the upper respiratory and GI tracts. Within 3 days and thereafter all cultures (including washed stools) revealed no growth.

The infant has received 2 marrow grafts from an unrelated female donor differing by one allele but matched by MLC. Ten days after the 1st, the maculopapular rash of graft vs host(GVH) began. Eosinophilia and hepatosplenomegaly are the only other signs of GVH. The patient shows early reconstitution:palpable nodes, synthesis of IgM and IgA, weak PHA responses, lymphocytes with donor specificity. Previous marrow grafts in SCID using an unrelated donor have led to severe GVH with fatal infectious complications. This infant has had mild GVH without infection.

Log in or create a free account to read this content

Gain free access to this article, as well as selected content from this journal and more on nature.com

Access through your institution

or

Sign in or create an account

Continue with Google

Continue with ORCiD