Transplantation of incompatible bone marrow in infants with severe combined immunodeficiency disease.

Our efforts to overcome the fatal GVH disease following transplantation of incompatible bone marrow have been: 1) isolation of patient in sterile laminar flow room, 2) elimination of bacterial flora from GI tract, 3) repeated infusions of plasma containing blocking antibodies, 4) selection of HL-A identical but unrelated donor from general population, 5) use of stem-cell fraction of bone marrow and 6) gradual transplantation of marrow (less than 0.01 ml) carefully aspirated, free of immunocompetent T-cell contamination. A mild form of GVH disease, partial reconstitution of immune function and hematologic chimera were noted in 2 patients, who survived 67 days and 125 days after transplantation. More recently, an infant with severe combined immunodeficiency disease (SCID) has been reconstituted immunologically using marrow from HL-A mismatched, mixed leukocytes culture (MLC) non-reactive donor. The gradual transplantation method may be a useful means of transplanting incompatible marrow in infants with SCID.