Plasma exchange for removal of anti-A and anti-B group antibodies in AB0 major-incompatible bone marrow transplantation

Between 1980-1986 seven patients underwent AB0-major incompatible bone marrow transplantation. Incompatible anti-A and anti-B antibodies could be decreased by the plasma exchange from titers 8-256 down to 0-8. Our practice combined with additional depletion of erythrocytes from marrow allowed to transplant all patients successfully, however, one patient demonstrated an acute haemolytic reaction during infusion of marrow. Plasma exchange was fairly well tolerated, however, 4 patients developed slight urticarial reactions. Both thrombocytopenic patients overcompensated the platelet loss caused by the exchange.     

Auto anti-A1 and auto anti-NA1 after bone marrow transplantation

The production of auto anti-A1 and auto anti-NA1 antibodies in patient with aplastic anemia has been described. The patient of group A1 received bone marrow from his brother of group A2. For immunosuppression cyclosporine A was administered.     

Isoimmune anti-A blood group reagents in pigs

Immunization or reimmunization of A-negative pigs with red blood cells (RBC) from A-positive donors yielded anti-A antibodies reacting in high titres with pheno-type A(Ac) RBC and, in some cases, in low dilutions, with phenotype Aw(Ap) RBC also. An attempt to raise the anti-A level by immunization with saliva which contained A substance was likewise successful.
Repeated immunization of A-negative recipients with the RBC of A-positive donors (compatible in all other factors), with the aid of adjuvant, is recommended as the best way of obtaining Aw typing reagents.     

Differing reactions of monoclonal anti-A antibodies with oligosaccharides related to blood group A

Inhibition radioimmunoassays with blood group A-related oligosaccharides have been used to investigate the specificities of six monoclonal anti-A antibodies, three of which had been intentionally generated by immunization of mice with blood group A erythrocytes and A-active blood group substance, and three were incidentally produced following immunization of mice with human tonsil cell membranes or a human colon cancer cell line. By hemagglutination, these antibodies are highly specific for human blood group A erythrocytes. However, they differ from one another in their reaction patterns with mono- and difucosyl A antigen structures and the corresponding afucosyl sequences on Type 1 and Type 2 backbone structures. The six antibodies, together with four previously characterized anti-A monoclonal antibodies (originally raised against the receptor for epidermal growth factor) have been classified into five groups. The first two groups consist of antibodies with broad specificities for A-related structures. There are five antibodies in the first group (TL5, 29.1, A17/3D1, MH2/6D4, and MH1/5D1) reacting to varying degrees with the mono- and difucosyl A antigen structures on either type of backbone sequence. In the second group are two antibodies (A15/3D4 and A15/3D3) which are difficult to inhibit with the oligosaccharides tested, but they reacted best with monofucosyl A structure on either type of backbone. Each of the remaining three antibodies had a distinct and more restricted reaction pattern, with a specificity for the difucosyl A antigen on both types of backbone (antibody EGR/G49) or the Type 1-based mono- and difucosyl A antigen structures (antibody MAS 016c) or the Type 2-based monofucosyl A antigen structure (antibody 455). The reactions of four of the antibodies with N-acetylgalactosamine or with oligosaccharides containing the afucosyl sequence GalNAc alpha 1-3Gal suggest that they may react with certain glycoconjugates with alpha-N-acetylgalactosaminyl termini ("A-like" structures) that are unrelated to the products of the blood group A gene-specified alpha-N-acetylgalactosaminyl-transferase. Knowledge of the differing reactions of these monoclonal antibodies is important for interpreting their reactions with glycoproteins and glycolipids of diverse origins.     

血型单克隆抗体试剂稳定剂的研究

为了进一步提高抗A、抗B血型单克隆抗体试剂的稳定性,实验中分别以不同配比的甘油、蔗糖、明胶和EDTA为稳定剂主要成分加入血型单抗试剂,放置在不同条件下观察试剂的稳定性。结果表明,所筛选出的一种稳定剂对血型单抗试剂具有良好的保护作用,试剂在2~8℃条件下放置12个月,凝集效价保持不变,并且该稳定剂对血型单抗的特异性、亲和力、凝集效价和凝集强度均无影响。     

Isoimmune anti-A blood group reagents in pigs.

Immunization or reimmunization of A-negative pigs with red blood cells (RBC) from A-positive donors yielded anti-A antibodies reacting in high titres with phenotype A(Ac) RBC and, in some cases, in low dilutions, with phenotype Aw(Ap) RBC also. An attempt to raise the anti-A level by immunization with saliva which contained A substance was likewise successful. Repeated immunization of A-negative recipients with the RBC of A-positive donors (compatible in all other factors), with the aid of adjuvant, is recommended as the best way of obtaining Aw typing reagents.     

Monoclonal antibodies to carbohydrate antigens in autologous bone marrow transplantation

Normal and malignant myeloid cells express a highly immunogenic oligosaccharide, lacto-n-fucopentaose-III (LNF-III), that has been identified by numerous monoclonal antibodies (MoAb). We have been interested in the use of a particular monoclonal antibody to LNF-III, PM-81, in the treatment of patients with acute myelogenous leukemia using the antibody to treat bone marrow in vitro. Following in vitro treatment of bone marrow with PM-81 and another MoAb, AML-2-23, the remaining cells are used as an autograft in a patient treated with high-dose chemotherapy and radiotherapy. In order to enhance the ability of the MoAb to lyse leukemic cells in the remission bone marrow, we have explored the effect of neuraminidase treatment on leukemia cells. In this paper we describe that myeloid leukemia cells expressing low levels of LNF-III by immunofluorescence can be shown to have high levels of LNF-III after neuraminidase treatment. In addition, we show that normal bone marrow progenitor cells do not have cryptic LNF-III antigen, thus allowing the application of this finding to the clinical setting. Moreover, we have shown that leukemia colony-forming cells from one patient with acute myelogenous leukemia express cryptic LNF-III and that after exposure to neuraminidase there was an increased ability of PM-81 in the presence of complement to eliminate these colony forming cells. These data indicate that the LNF-III moiety is almost universally expressed on myeloid leukemia cells and their progenitors but not expressed on normal progenitors. Thus, it may be possible to enhance leukemia cell kill in vitro by neuraminidase treatment of bone marrow.     

No narcosis for bone marrow harvest in autologous bone marrow transplantation

A prospective study with mild general analgesia and sedation together with local anesthesia during bone marrow harvest was performed. Thirty-one patients underwent 33 bone marrow collections. Pretreatment consisted of 100 mg meperidine i.m. and 20 mg diazepam i.m. 1 h before start of procedure. Eight patients got additional meperidine and diazepam during the procedure, all patients got lidocaine 1% locally. A mean volume of 1.321 was obtained with 42.5 punctures. Twenty-two patients had no complications, 4 vomited, 4 had easily correctable hypotension of short duration, one got oxygen for cyanosis of short duration. Acceptance was good in 23 patients, in 6 reasonably well, in two bad. Only one patient experienced pain problems, due to suction. Anxiety was no major problem due to good information before the procedure and mild sedation. This form of anesthesia for bone marrow collection is a safe procedure, it is generally well accepted by the patient and it can be performed on an out-patient basis.     

Immunochemical studies on blood groups. The combining site specificities of mouse monoclonal hybridoma anti-A and anti-B

Mouse monoclonal hybridomas, five anti-blood group A, three anti-B, and one anti-AB, produced by various methods of immunization, have been characterized by quantitative precipitin tests and the fine structures of their combining sites have been mapped by oligosaccharide inhibition assays. The combining sites of antibodies of each specificity differed among themselves. Three of the five monoclonals were specific for difucosyl and two for monofucosyl A determinants. All but the anti-AB were strictly specific for blood group A or blood group B erythrocytes; all of the anti-A monoclonals gave essentially equivalent titers in hemagglutination tests with A1 and A2 erythrocytes except for a monoclonal anti-A prepared by immunization with a human gastric cancer cell line. The data provide additional evidence for the heterogeneity of the antibody response to the different antigenic determinants present on blood A and B substances and emphasize the importance of difucosyl determinants which comprise most of the determinants on the water-soluble blood group substances.     

Frontiers in bone marrow transplantation

The early murine experiments and human studies that indicated the potential of marrow transplantation are reviewed. The results of marrow grafting for a variety of human diseases are summarized. Current directions of research are indicated.