Distinctive infectious complications in patients with central nervous system lymphoma undergoing thiotepa, busulfan, and cyclophosphamide-conditioned autologous stem cell transplantation Journal Article


Authors: Scordo, M.; Morjaria, S. M.; Littmann, E. R.; Bhatia, A.; Chung, H. H.; Maloy, M.; DeAngelis, L. M.; Giralt, S. A.; Taur, Y.; Sauter, C. S.
Article Title: Distinctive infectious complications in patients with central nervous system lymphoma undergoing thiotepa, busulfan, and cyclophosphamide-conditioned autologous stem cell transplantation
Abstract: We investigated the incidence of viral, fungal, bacterial, and parasitic infections observed in 57 patients with central nervous system lymphoma after thiotepa, busulfan, and cyclophosphamide-conditioned autologous stem cell transplantation (TBC-ASCT) and 79 patients with systemic non-Hodgkin lymphoma after traditional carmustine, etoposide, cytarabine, and melphalan–conditioned ASCT (BEAM-ASCT). Twenty of 57 (35%) TBC-ASCT patients had detectable viremia with human herpesvirus 6, cytomegalovirus, adenovirus, or BK virus, versus 9 of 79 (11%) BEAM-ASCT patients. Eight TBC-ASCT patients had clinically relevant viral infections (4 human herpesvirus 6, 2 cytomegalovirus, 1 adenovirus, 2 BK virus), versus 0 in the BEAM-ASCT group. Four TBC-ASCT patients suffered infections from either a fungal or parasitic pathogen versus 1 BEAM-ASCT patient. TBC was associated with greater risk of viral reactivation compared with BEAM, independent of other factors (hazard ratio, 4.42; 95% confidence interval, 1.9 to 11.3; P <.001). Prolonged lymphopenia and steroid use in the peri- and post-ASCT period did not explain these observed differences. The pathogenesis of these unusual infections in TBC-ASCT patients remains incompletely understood, and may involve more potent immune suppression with TBC conditioning. Clinicians should be aware of these differences in infection risk in TBC-ASCT patients, which more closely parallel those seen in allogenic hematopoietic cell transplantation recipients. New prophylactic approaches to help minimize these infections should be considered in this population. © 2018 The American Society for Blood and Marrow Transplantation
Keywords: adult; controlled study; middle aged; major clinical study; busulfan; primary central nervous system lymphoma; cytarabine; etoposide; cyclophosphamide; melphalan; autologous stem cell transplantation; carmustine; thiotepa; nonhodgkin lymphoma; transplantation conditioning; virus infection; bacterial infection; adenovirus infection; cytomegalovirus infection; mycosis; infection risk; virus reactivation; infectious complication; viremia; herpes virus infection; parasitosis; central nervous system lymphoma; diffuse large b cell lymphoma; infectious complications; human; male; female; article; human herpesvirus 6; bk virus infection; high-dose therapy and autologous stem cell transplantation
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 24
Issue: 9
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2018-09-01
Start Page: 1914
End Page: 1919
Language: English
DOI: 10.1016/j.bbmt.2018.04.013
PUBMED: 29679773
PROVIDER: scopus
PMCID: PMC6163063
DOI/URL:
Notes: Article -- Export Date: 1 November 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Sergio Andres Giralt
    538 Giralt
  2. Craig Steven Sauter
    167 Sauter
  3. Ying Taur
    88 Taur
  4. Molly Anna Maloy
    133 Maloy
  5. Michael Scordo
    40 Scordo
  6. Helen Helen Hea-young Chung
    3 Chung
  7. Ankush Bhatia
    7 Bhatia