Ex-vivo treatment of donor bone marrow with anti-T-cell immunotoxins for prevention of graft-versus-host disease.

Two patients undergoing marrow transplantation for acute lymphocytic leukaemia in third remission received from histocompatible siblings marrow pretreated with a mixture of three anti-T-cell immunotoxins, consisting of murine monoclonal antibodies covalently linked to ricin. This marrow processing effectively eliminated functional T-cell responses while preserving the marrow precursors necessary for sustained haematoimmunopoietic engraftment. No post-transplant immunoprophylaxis was administered. Both patients showed prompt peripheral engraftment and were discharged from hospital within a month of transplantation. No toxic effects or graft-versus-host disease were apparent after the administration of immunotoxin-treated marrow. Ex-vivo immunotoxin pretreatment appears a safe and simple procedure which deserves further clinical testing as a sole method of graft-versus-host disease prophylaxis.