In immunosuppressed patients, a high rate of complications due to opportunistic infection is known. We report the case of a 36 year old patient with ulcerative colitis and a septic complication with ongoing pancytopenia. Due to colonic perforation, colectomy had to be performed. Despite this intervention, the septic constellation persisted. The pancytopenia in peripheral blood counts also persisted with the necessity of repetitive transfusions. A bone marrow biopsy showed an infiltration with Leishmania bodies in macrophages. Tissue culture allowed for typing of the parasites as belonging to the L. donovani/infantum complex, DNA sequencing confirmed infection with L. infantum. This infection must have been contracted during a vacation on Mallorca about 1.5 years earlier. Administration of liposomal amphotericin B cured the patient. Surprisingly, histological examination of the resected colon reveiled the presence of an immunoblastic B-cell lymphoma. In this case, immunosuppression was a prerequisite for the manifestation of leishmaniosis.

Seventeen patients with relapsed, acute leukemia were grafted with bone marrow from HLA-identical siblings by the 'Munich Cooperative Group for Bone Marrow Transplantation' during the period from August 1975 to June 1980. The antileukemic and immunosuppressive conditioning treatment consisted of high doses of bischlorethyl nitrosourea, Cytosine-Arabinoside and Cyclophosphamide, as well as, total body irradiation of about 9 Gy (midline body dose) from dual 60Cobalt sources. Methotrexate was given to all patients for prophylaxis of graft-versus-host disease (GvHD). Nine patients received marrow that was treated with anti-T-cell globulin (ATCG) "in vitro".--Crossreacting antibodies against hemopoietic stem cells were removed by absorption. Two of 5 evaluable patients given untreated marrow developed chronic GvHD, while patients given ATCG-treated marrow did not show unequivocal symptoms of GvHD. Six patients are in complete remission one to 33 months following bone marrow transplantation (b.m.t.) Five patients died with relapses of leukemia between 3 1/2 and 24 months following b.m.t., 3 patients died with interstitial pneumonia within 3 months of b.m.t. and 3 patients died with insufficient graft function within 4 weeks of b.m.t. Four of thirteen patients that were grafted more than 6 months ago are presently alive and in continuous complete remission at 11, 14, 29 and 33 months following b.m.t. Our results confirm that longterm remissions can be obtained with b.m.t. in patients with acute leukemia in advanced stage.

SUMMARYThe objective of this study was to investigate the expression of MHC antigens by retinal pigment epithelium cells (RPE) after stimulation with interferon-gamma (U-N--/) and to improve the currently practised technique of cadaver HLA typing. A concentration of 100 U/ml lFN-y induced expression of class I molecules up to >90% 3 days after stimulation, whereas 50 U/mi were required for the expression of HLA-DR to > 90%. A concentration of 750 U/ml induced 35-45% expression of HLA-DP and <25% HLA-DQ after 3 days. Cells were scrologically typed using the standard lymphocytotoxicity assay 3 days after stimulation with 250 U/ml IFN-y. Typing of class I specificities was complemented by onc-dimcnsiona! isoelectric focusing (ID-IEF). We observed high concordance between the results of the RPE typing and the lymphocytotoxicily test on the same donors. Our results show complete typing of class I and 11 antigens post-mortem, which, in particular, enables graft matching and improvement of graft survival in recipients of organs removed many hours after death such as the cornea.

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