Successful engraftment of NA1 positive bone marrow in a patient with the neutrophil antibody, anti-NA1

Phyllis I. Warkentin, Mary E. Clay, John H. Kersey, Norma K.C. Ramsay, Jeffrey McCullough

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

An 11-yr, 9-mo-old girl with a 5-hr history of severe aplastic anemia unresponsive to androgen or steroid therapy was treated with a bone marrow transplant from her 7-yr-old, HLA-MLC identical ABO incompatible, male sibling. Donor neutrophils were positive for the NA1 antigen. The patient's pretransplant serum contained a neutrophil specific antibody, anti-NA1, reactive against donor neutrophils, which was demonstrable by both granulocyte agglutination and granulocyte cytotoxicity assays. The transplant preparative regimen consisted of cyclosposphamide, 50 mg/kg/day for 4 days, and total lymphoid irradiation (750 rads, 26 rads/min by 4 meV linear accelerator). A two plasma volume exchange (4,800 ml) by continuous flow centrifugation with an Amino cell separator was performed one day prior to transplant because of ABO incompatibility. Following plasma exchange, anti-NA1 cytotoxic titer, 1:8 preexchange, was no longer detectable; anti-NA1 agglutinating titer had only decreased from 1:64 to 1:32. She experienced no adversed reaction to transplantation of 4.8 × 108 nucleated cells/kg. Marrow engraftment was demonstrable by Day 14 by steadily increasing leukocyte and platelet counts, red cells of donor ABO group, and bone marrow chromosomes showing a normal male, 46 XY karyotype. This case of successful bone marrow engraftment without delayed neutrophil recovery in the presence of a neutrophil specific antibody NA1 suggests that neutrophil specific antigens are not functionally present on the pluripotent stem cell. Histoincompatibility for neutrophil specific determinants need not eliminate the possibility of bone marrow transplantation for aplastic anemia between siblings identical for the major histocompatibility loci.

Original languageEnglish (US)
Pages (from-to)173-184
Number of pages12
JournalHuman Immunology
Volume2
Issue number2
DOIs
StatePublished - Mar 1981

Fingerprint

Anti-Idiotypic Antibodies
Neutrophils
Bone Marrow
Plasma Exchange
Aplastic Anemia
Tissue Donors
Transplants
Granulocytes
Siblings
Lymphatic Irradiation
Antigens
Particle Accelerators
Pluripotent Stem Cells
Histocompatibility
Plasma Volume
Agglutination
Bone Marrow Transplantation
Platelet Count
Karyotype
Centrifugation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Successful engraftment of NA1 positive bone marrow in a patient with the neutrophil antibody, anti-NA1. / Warkentin, Phyllis I.; Clay, Mary E.; Kersey, John H.; Ramsay, Norma K.C.; McCullough, Jeffrey.

In: Human Immunology, Vol. 2, No. 2, 03.1981, p. 173-184.

Research output: Contribution to journalArticle

Warkentin, Phyllis I. ; Clay, Mary E. ; Kersey, John H. ; Ramsay, Norma K.C. ; McCullough, Jeffrey. / Successful engraftment of NA1 positive bone marrow in a patient with the neutrophil antibody, anti-NA1. In: Human Immunology. 1981 ; Vol. 2, No. 2. pp. 173-184.
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abstract = "An 11-yr, 9-mo-old girl with a 5-hr history of severe aplastic anemia unresponsive to androgen or steroid therapy was treated with a bone marrow transplant from her 7-yr-old, HLA-MLC identical ABO incompatible, male sibling. Donor neutrophils were positive for the NA1 antigen. The patient's pretransplant serum contained a neutrophil specific antibody, anti-NA1, reactive against donor neutrophils, which was demonstrable by both granulocyte agglutination and granulocyte cytotoxicity assays. The transplant preparative regimen consisted of cyclosposphamide, 50 mg/kg/day for 4 days, and total lymphoid irradiation (750 rads, 26 rads/min by 4 meV linear accelerator). A two plasma volume exchange (4,800 ml) by continuous flow centrifugation with an Amino cell separator was performed one day prior to transplant because of ABO incompatibility. Following plasma exchange, anti-NA1 cytotoxic titer, 1:8 preexchange, was no longer detectable; anti-NA1 agglutinating titer had only decreased from 1:64 to 1:32. She experienced no adversed reaction to transplantation of 4.8 × 108 nucleated cells/kg. Marrow engraftment was demonstrable by Day 14 by steadily increasing leukocyte and platelet counts, red cells of donor ABO group, and bone marrow chromosomes showing a normal male, 46 XY karyotype. This case of successful bone marrow engraftment without delayed neutrophil recovery in the presence of a neutrophil specific antibody NA1 suggests that neutrophil specific antigens are not functionally present on the pluripotent stem cell. Histoincompatibility for neutrophil specific determinants need not eliminate the possibility of bone marrow transplantation for aplastic anemia between siblings identical for the major histocompatibility loci.",
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