Bone Marrow Failure |
1 Haematology Unit, G.Gaslini Childrens Hospital. Genoa
2 Oncology Laboratory, G.Gaslini Childrens Hospital, Genoa
3 Epidemiology and Biostatistics Unit, G.Gaslini Childrens Hospital, Genoa
4 Haematology Unit, Regina Margherita Hospital, Torino
5 Haematology Unit, San Martino Hospital, Genoa
6 Pediatric Clinic, University of Milan "La Bicocca", Monza
7 Haematology Unit, University "La Sapienza", Rome
8 Pediatric Onco-Haematology Clinic, University of Padua, Padua
9 Haematology Unit, San Camillo-Forlanini Hospital, Rome
10 Pediatric Hematology Unit, Pausillipon Hospital, Naples
11 Pediatric Onco-Haematology Clinic, University of Catania, Catania, Italy
Correspondence: Carlo Dufour, MD Haematology Unit, G. Gaslini Childrens Hospital, Largo G.Gaslini 5, 16147 Genoa, Italy., E-mail: carlodufour{at}ospedale-gaslini.ge.it
Cytokine expression assessed by flow cytometry in 53 acquired aplastic anemia patients before and after combined immunosuppression (EBMT WPSAA protocols) showed that CD3+ marrow cells containing TNF-
, IFN-
and IL4 were similar in subjects with disease at onset (DO) and responsive to treatment who had more CD3+/TNF-
+ and CD 3+/IFN-
+ cells than normal controls. In vitro block of TNF-
and/or IFN-
significantly increased BFU-e over baseline in 28 patients. In responsive to treatment patients only TNF-
block significantly incremented colonies over normal controls. Absolute marrow CD3+/TNF-
+ and CD3+/IFN-
+ cells prospectively tested in a group of 21 subjects declined significantly more in Responders than in Non Responders to immunosuppression at Response Evaluation Time respect to Diagnosis. Both in Responders and in Non Responders these cells remained higher than in normal controls. This study suggests that immunosuppression does not fully clear excess TNF-
and IFN-
from marrow of patients with good outcome and raises the hypothesis that additional cytokine blockade might be useful in immunosuppression for acquired aplastic anemia.
Key words: TNF-
, IFN-
, IL4, aplastic anemia, immunosuppression.