Bone Marrow Transplantation

Bone marrow transplantation in man.-Georges Math#{233} ( Paris ) opened the discussion by reviewing the Yugoslavian reactor accident and discussing the clinical management of the exposed individuals. Adult homologous bone marrow or homologous fetal liver was used to treat five of the victims. One man died and the others survived with evidence of temporary transplantation of red blood cell-forming elements. In all the cases treated with bone marrow there was a delay of three to four weeks in giving the marrow. In the discussion that followed Math#{233}’s report it was brought out by Ferrebee and Math#{233}that they thought delay in bone marrow transplantation after irradiation was warranted and possibly desirable if the patient could be controlled for a time by symptomatic treatment. A 10 day delay was mentioned. Andrews commented on the Yugoslavian cases and compared them to the Y-12 accident victims. He thought that all the Yugoslavian patients received more irradiation than the most heavily exposed victim in the Y-12 accident. No bone marrow was given to the Y-12 cases, and all have shown satisfactory recovery from the acute radiation syndrome. Math#{233} also reported experimental studies on bone marrow transplantation in irradiated leukemic mice. His best results in mice were obtained when he irradiated the mice and treated them with homologous bone marrow at a time when they had the fewest tumor cells. He felt that a graft against tumor cell reaction was most effective when it had the fewest tumor cells to react against. He described two cases of acute leukemia in children treated during remission with radiation exposures of about 900 rads. Fresh homologous adult bone marrow was given some days after the irradiation. In both patients about 45 days after the bone marrow transplantation a secondary disease-like process developed with weight loss, gastrointestinal disturbances and fever. It cleared up with symptomatic treatment. In both patients serotyping technics showed a persistent level of donor-type erythrocytes indicating a “take” of the homologous marrow. The two patients were still in remission about 80 days after the radical therapy. McGovern (Boston) described a case of acute leukemia in a child from whom he had taken bone marrow during a remission. Later, when drug therapy failed, 600 r of total-body irradiation was given and the preserved autologous marrow was reinfused. A remission of about 88 days was obtained before death from a transfusion complication. Two other cases mentioned by McGovern were given about the same amount of radiation and treated with homologous bone marrow; however, there was no beneficial effect. Ferrebee (Cooperstown, N.Y.), pointed out that in the treatment of acute leukemics by whole-body irradiation in the exposure range of 200 to 1000 r the duration of remissions in most patients surviving the radiation was usually about two to three months. This is about the same as that seen after similar