Summary:expressed in the hematopoietic marrow,  thalassemia is rationally curable by allogeneic bone marrow transplantation (BMT). The effectiveness of this treatment was demBeta thalassemia is a hereditary anemia curable by bone marrow transplantation (BMT). Class 3 patients have a onstrated more than a decade ago. 1 The largest trial reported to date is by Lucarelli et al 2 and included 697 much worse outcome with a high incidence of rejection after BMT. Adhesion molecules, including the interpatients. The authors stratified the thalassemic patients younger than 16 years of age into three risk classes progcellular adhesion molecule 1 are thought to play an essential role in the rejection process. To investigate nostic for the outcome after BMT. Results from this study showed that class 3 patients had a much worse outcome, whether increased levels of soluble intercellular adhesion molecule 1 (sICAM-1) may be predictive of with a dramatically higher incidence of rejection compared to class 1 or class 2 patients. graft rejection, the pretransplant serum concentration of sICAM-1 of 27  thalassemic patients who rejectedGraft rejection occurs when recipient immune cells recognize donor target cells as non-self and set in motion an the graft was compared to that of 68  thalassemic patients who achieved a sustained engraftment. Fifty inflammatory process by activating effector T lymphocytes capable of damaging the graft. 3 In order for effector cells serum samples, obtained from marrow donors, matched for age and sex, served as controls.  thalassemic to infiltrate the graft an intercellular contact is needed and adhesion molecules are thought to play a pivotal role during patients had significantly higher sICAM-1 concentrations as compared to controls (P = 0.0001). Signifithe rejection inflammatory process. 4 One adhesion pathway in man involves the 2 leukocyte cantly increased levels of sICAM-1 were found in the patients who subsequently rejected the graft (mean integrin LFA-1 (CD11a/CD18) and its ligand, the intercellular adhesion molecule 1 (ICAM-1/CD54). 5,6 The (95% CI) = 490 ng/ml (440; 540) ) as compared to those with sustained engraftment (400 ng/ml (384; 415) ), (P ICAM-1 molecule is a single chain glycoprotein of 90 kDa, composed of five Ig-like extracellular domains, a hydro-= 0.004). The mean level of sICAM-1 in patients with early rejection was significantly higher than that in phobic transmembrane domain and a short cytoplasmic domain. ICAM-1 is constitutively expressed on many hempatients with late rejection (P = 0.04). This may indicate a transfusion-mediated role of sICAM-1: some  thalasatopoietic and on several non-hematopoietic cell surfaces, including vascular endothelial cells, thymic and mucosal semic patients with high sICAM-1 levels, induced by the transfusion support, may remain immunologically epithelial cells, fibroblasts, dendritic cells in germinal centers and T cells in lymphoid tissues. 7 ICAM-1 may be active, despite the conditioning regimen, therefore such patients are likely to ...