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Summary:suicide among cancer patients is unknown. 5 Cancer patients, due to the multiplicity of stressors that they experience, may believe that suicide offers the only escape from Two cases of patients who attempted suicide following BMT and one case of a patient with suicidal ideation the unendurable pain, depression or unrelenting symptoms of the disease. during his isolation period for BMT are reviewed. The factors which contributed to this situation are investi-We report three cases of suicidal behaviour in BMT patients, of which one was successful. The three cases gated. Finally, issues relating to psychological interventions are briefly discussed received their BMT in two UK centres. Two of these cases were long-term survivors and the third was a patient in isoKeywords: suicide; bone marrow transplantation lation immediately after receiving a marrow transplant. These cases occurred over a period of 3 years. Two more cases demonstrated suicidal behaviour during the same 3-Although there has been increasing interest in the emotional year period, but are not detailed here. About 312 transplants aspects of bone marrow transplantation (BMT) in the last were carried out during this period in these two BMT cendecade or so, 1 suicide has not been investigated thoroughly tres. in the BMT literature. BMT involves numerous stressesThe aims of the current case study are as follows: (1) to such as the decision to undergo marrow transplantation, increase awareness of the issue of suicide during BMT; aggressive pre-transplant conditioning, immunosuppres-(2) to identify patient characteristics that may contribute to sion, isolation for a prolonged period of time, the 'waiting' suicide/suicidal ideation; and (3) to offer suggestions for period for the marrow engraftment, numerous treatment the management of potentially suicidal BMT patients. complications, and finally the long period of adjustment.

Anti-CD4 monoclonal antibodies are potential therapeutic agents for the prevention of autoimmune disease and treatment of rejection after organ transplantation and are capable of both restoring tolerance to self-antigens and inducing tolerance to antigens introduced under the cover of the antibody therapy in vivo. Tolerance to donor alloantigens can be induced in vivo by administering donor alloantigen in combination with either depleting (YTA 3.1) or nondepleting (YTS 177) anti-CD4, 28 days before heart transplantation in the mouse. The effect of anti-CD4 on proximal T-cell receptor (TCR) signalling pathways and proliferation was investigated in vitro and in vivo in the presence and absence of YTA 3.1 or YTS 177. Anti-CD4 was found to perturb proximal signalling events upon TCR/CD3 ligation, resulting in reduced tyrosine phosphorylation of Zap-70 and LAT (linker for activation of T cells) and reduced association of tyrosine-phosphorylated LAT with lck. This ultimately resulted in severely reduced proliferation of the responding CD4 þ T cells. The signalling profile of the anti-CD4-treated cells resembled that of anergic T cells. This could be a result of a common mechanism involving perturbation in the formation of the central supramolecular activation cluster of the immunological synapse by impaired recruitment of CD4 and CD28, thereby resulting in severely reduced lck activation.