Serious infection risk and immune recovery after double-unit cord blood transplantation without antithymocyte globulin Journal Article

Authors: Sauter, C.; Abboud, M.; Jia, X.; Heller, G.; Gonzales, A. M.; Lubin, M.; Hawke, R.; Perales, M. A.; Van Den Brink, M. R.; Giralt, S.; Papanicolaou, G.; Scaradavou, A.; Small, T. N.; Barker, J. N.
Article Title: Serious infection risk and immune recovery after double-unit cord blood transplantation without antithymocyte globulin
Abstract: Factors contributing to infection risk after cord blood transplantation (CBT) include the use of anti-thymocyte globulin (ATG), prolonged neutropenia, and failure to transfer immunity. In the present study, we investigated the potential of double-unit CBT without ATG to reduce the risk of infection and evaluated the nature of serious infections in the first year after CBT using this approach. Seventy-two predominantly adult patients underwent CBT for hematologic malignancies; of these, 52 patients received myeloablative conditioning, and 20 received nonmyeloablative conditioning. The peak incidences of bacterial infections (32%), fungal infections (14%), and bacterial/fungal pneumonias (10%) occurred in the first 30 days posttransplantation. Three such infections contributed to early mortality. The peak incidence of viral infections was 31-60 days posttransplantation, affecting 30% of patients. Cytomegalovirus (CMV) was the most common viral infection. CMV infections occurring before day 120 (n = 23) had no relationship with graft-versus-host disease (GVHD), whereas CMV infections occurring after day 120 (n = 5), along with all cases of Epstein-Barr virus viremia (n = 5) and adenoviral enteritis (n = 2), occurred exclusively in the context of GVHD therapy or corticosteroid use for another indication. Viral infections had the highest lethality: 2 were a direct cause of death, and 3 contributed to death. Patients exhibited steady immune recovery, achieving a median CD3+4+ T cell count >200 cells/μL by day 120 post-CBT, and no infection-related deaths occurred after day 120. Our results suggest that double-unit CBT without ATG is associated with prompt T cell recovery, and, unlike in CBT incorporating ATG, infection is rarely a primary cause of death. However, CBT without ATG is associated with a significant risk of GVHD, and serious infections remain a challenge, especially in the setting of GVHD. New strategies are needed to further reduce infectious complications after CBT; these will require earlier neutrophil recovery and more effective prevention of GVHD, ideally without the profound T cell depletion associated with ATG therapy. © 2011 American Society for Blood and Marrow Transplantation.
Keywords: adolescent; adult; child; controlled study; preschool child; school child; aged; child, preschool; middle aged; leukemia; retrospective studies; human cell; major clinical study; fludarabine; follow-up studies; infection; risk factors; aciclovir; cyclophosphamide; melphalan; herpes simplex; chronic myeloid leukemia; thiotepa; hodgkin disease; time factors; febrile neutropenia; acute leukemia; cord blood stem cell transplantation; myeloablative conditioning; myelodysplastic syndrome; nonmyeloablative conditioning; hematologic neoplasms; infant; graft versus host reaction; transplantation conditioning; enteritis; immunity; lymphatic leukemia; immunologic factors; vancomycin; cyclosporin a; graft vs host disease; mycophenolic acid 2 morpholinoethyl ester; bacterial infection; adenovirus infection; cytomegalovirus infection; mycosis; posaconazole; voriconazole; cytomegalovirus; clofarabine; micafungin; herpesvirus 4, human; opportunistic infection; epstein-barr virus infections; quinolone; aminoglycoside; epstein barr virus infection; anti-thymocyte globulin; unrelated donor umbilical cord blood transplantation; lung mycosis; cytomegalovirus infections; antilymphocyte serum; piperacillin; tazobactam
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 17
Issue: 10
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2011-01-01
Start Page: 1460
End Page: 1471
Language: English
DOI: 10.1016/j.bbmt.2011.02.001
PROVIDER: scopus
PMCID: PMC3165093
PUBMED: 21310254
Notes: --- - "Export Date: 3 October 2011" - "CODEN: BBMTF" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Trudy Small
    234 Small
  2. Glenn Heller
    376 Heller
  3. Xiaoyu Jia
    46 Jia
  4. Sergio Andres Giralt
    844 Giralt
  5. Craig Steven Sauter
    311 Sauter
  6. Miguel-Angel Perales
    690 Perales
  7. Juliet N Barker
    313 Barker
  8. Michelle Abboud
    15 Abboud
  9. Rebecca M Hawke
    12 Hawke
  10. Marissa N Lubin
    79 Lubin