Severe infections after allogeneic peripheral blood stem cell transplantation: a matched-pair comparison of unmanipulated and CD34+ cell-selected transplantation

• Published in: Haematologica (Roma) 2001-10, Vol.86 (10), p.1075-1086
• Main Authors: Martino, R, Rovira, M, Carreras, E, Solano, C, Jorge, S, De La Rubia, J, Caballero, MD, de Oteyza, JP, Zuazu, J, Moraleda, JM, Ojeda, E, Ferra, C, Serrano, D, De La Camara, R, Urbano-Ispizua, A, Brunet, S, AlloPBSCT and Infectious/Non-infectious Complications Subcommittes of Grupo Espanol de Trasplante Hematopoyetico (GETH)
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD34; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Cytomegalovirus Infections - etiology; Cytomegalovirus Infections - mortality; Cytomegalovirus Infections - prevention & control; Female; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Infection - etiology; Infection - mortality; Lymphocyte Depletion; Male; Matched-Pair Analysis; Medical sciences; Middle Aged; Retrospective Studies; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Homologous - adverse effects
• ISSN: 0390-6078; 1592-8721

Servei d'Hematologia Clinica, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni M0 Claret, 167, 08025 Barcelona, Spain. [e-mail] BACKGROUND AND OBJECTIVES: T-cell depletion of the graft delays immune recovery following allogeneic peripheral blood stem cell transplantation (PBSCT), but it is not clear whether it actually increases the risk of severe infections after the transplant. DESIGN AND METHODS: We have compared the occurrence of severe infections following 162 CD34+ cell-selected allogeneic PBSCT and 162 unmanipulated PBSCT (CD34+ and UM groups, respectively) from HLA-identical siblings. RESULTS: The probability of infection-related mortality (IRM) was 22% in the UM group and 31% in the CD34+ group (log-rank, p=0.2). In multivariate analyses only the use of fluconazole prophylaxis showed a protective effect on IRM in the whole set of patients, while in both transplant groups the most significant factor was the development of moderate-to-severe graft-versus-host disease (GVHD). The probability of developing cytomegalovirus (CMV) infection was 42% in the UM group and 59% in the CD34+ group (p=0.002), with no differences in CMV disease (10% and 9%, respectively). Multivariate analysis of CMV infection identified three variables associated with a higher risk in the whole set of patients: CMV positive serostatus, CD34+ transplant group and recipient age above 40 years. The development of moderate-to-severe GVHD was a significant factor only in the UM group. Disseminated varicella-zoster virus infection was more common in the CD34+ group (19% and 12%, p=0.05), as were early (