The effect of white cell depletion of red cells and platelet concentrates on the transmission of cytomegalovirus (CMV) was studied retrospectively in 150 patients treated intensively for acute leukemia or non-Hodgkin's lymphoma. CMV infection was diagnosed on the basis of IgM and IgG antibody responses to CMV late antigen (CMV-LA). Before cytoreductive therapy for their underlying disease, 59 patients were CMV seronegative and 91 were CMV seropositive. None of the 59 CMV-seronegative patients showed persistent seroconversion 2 months after the cytoreductive treatment. The comparison group, consisting of 312 cardiac surgery patients, showed a significantly higher incidence of primary CMV infections: 10 of 86 (11.6%, p = 0.004). Twenty-five percent of the CMV-seronegative patients and controls had transient IgG antibodies to CMV-LA without IgM antibodies, which is indicative of antibodies passively acquired via blood products. These results indicate that white cell-poor blood products carry a very low risk, if any, of CMV transmission. The policy of transfusing white cell-poor blood products provides a useful alternative to the selection of CMV-seronegative donors.
Transferrin-based toxin conjugates are strongly influenced by the presence of free transferrin and the iron saturation state. The corresponding alpha-transferrin receptor-immunotoxin does not show these disadvantages, has similar efficacy and should be preferred for further experiments.
Autopsy tissues of 19 patients with complications after bone marrow transplantation (BMT) were analysed for the presence of cytomegalovirus (CMV) using histochemical methods. CMV antigens were detected by antibodies to CMV Immediate Early Antigen (IEA) or CMV Late Antigen (LA). CMV‐DNA was detected by DNA in situ hybridization (DISH). IEA was detected in one or more tissues in 79% of 14 patients from whom frozen tissue was available. CMV‐DNA was detected on paraffin sections in 84% of all 19 patients. CMV components were present in all organs studied; the highest incidence was found in lung, gastrointestinal tract and kidney. In histology, only 37% of patients showed signs of CMV infection by the presence of cytomegalic cells with nuclear inclusions (or so called “owl eye cells”). In tissue culture, only 33% of 15 patients were CMV positive. Serologically, 68% of all patients had active CMV infection, as indicated by a rise in antibody titres. We conclude that the quick detection of CMV IEA and CMV‐DNA has a high sensitivity and predictive value, which is comparable to or exceeds the serological detection of CMV.
Several sensitive parameters of cellular immunity were studied in 20 patients with asymptomatic paraproteinaemia as judged after at least 3 years of follow‐up. In vitro lymphocyte transformation by the primary immunogen haemocyanin of Helix pomatia (HPH) following immunization, by PHA, PWM and previously encountered antigens was measured, as was skin sensitization by the primary immunogen dinitrochlorobenzene (DNCB). All 12 patients with low serum paraprotein levels—benign paraproteinaemia according to common criteria— had normal parameters of cellular immunity. However, 5 of 6 patients with high IgG and IgA serum paraprotein levels had a decreased response to HPH; 3 of these 5 also had a decreased PHA response. Two patients with high IgM serum paraprotein levels had normal lymphocyte reactivity. Lymphocyte reactivity by PWM and previously encountered antigens was normal in all patients. Autologous serum culture medium did not influence the results. DNCB skin sensitization was significantly lower in the group with high serum paraprotein levels than in the group with low levels. It is concluded, that in asymptomatic paraproteinaemia, patients with high serum paraprotein levels differ from those with low paraprotein levels in their defective cellular response to primary immunogens. The significance of these findings is discussed.
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