Higher risk of cytomegalovirus and aspergillus infections in recipients of T cell-depleted unrelated bone marrow: Analysis of infectious complications in patients treated with T cell depletion versus immunosuppressive therapy to prevent craft-versus-host disease Journal Article


Authors: van Burik, J. A. H.; Carter, S. L.; Freifeld, A. G.; High, K. P.; Godder, K. T.; Papanicolaou, G. A.; Mendizabal, A. M.; Wagner, J. E.; Yanovich, S.; Kernan, N. A.
Article Title: Higher risk of cytomegalovirus and aspergillus infections in recipients of T cell-depleted unrelated bone marrow: Analysis of infectious complications in patients treated with T cell depletion versus immunosuppressive therapy to prevent craft-versus-host disease
Abstract: Serious infections are a major obstacle limiting the usefulness of unrelated donor marrow transplantation. Graft-versus-host disease (GVHD) and its therapy are associated with a high risk of opportunistic infection. In this study, patients were randomized to receive 1 of 2 GVHD prophylaxis strategies, marrow T cell depletion, and cyclosporine (TCD) or methotrexate/cyclosporine (M/C) after transplantation. The patients underwent transplantation between March 1995 and October 2000 as part of a multicenter randomized trial. As a secondary analysis, we analyzed infections in this study cohort. Among the 404 patients who underwent transplantation, a total of 1598 infections were reported. The rates of serious and fatal infections did not differ between the TCD and M/C groups. Bacterial infections accounted for 1/3 of serious infections in each treatment arm. A significantly higher incidence of severe cytomegalovirus (CMV) and life-threatening or fatal aspergillus infections was observed in the patients receiving TCD (CMV, 28% vs 17% [P = .02]; aspergillosis, 16% vs 7% [P < .01]). The only independent risk factor for serious infection was the development of grade III-IV acute GVHD (aGVHD; hazard ratio = 1.41; 95% confidence interval = 1.03-1.91). Strategies to speed immune recovery, even in the absence of GVHD, are needed to overcome the risk of infection after unrelated donor transplantation. © 2007 American Society for Blood and Marrow Transplantation.
Keywords: adolescent; adult; controlled study; survival analysis; leukemia; retrospective studies; transplantation, homologous; acute granulocytic leukemia; major clinical study; clinical trial; neutropenia; monotherapy; comparative study; methotrexate; controlled clinical trial; infection; cohort studies; randomized controlled trial; incidence; cohort analysis; combination chemotherapy; hematopoietic stem cell transplantation; chronic myeloid leukemia; risk factor; acute graft versus host disease; disease severity; myelodysplastic syndrome; nonhodgkin lymphoma; multicenter study; graft versus host reaction; virus infection; acute lymphocytic leukemia; t cell depletion; immunosuppressive treatment; bone marrow transplantation; graft vs host disease; bacterial infection; ganciclovir; cytomegalovirus infection; mycosis; cyclosporin; cyclosporine; immunosuppressive agents; cytomegalovirus; infection risk; lymphocyte depletion; aspergillosis; graft recipient; opportunistic infections; immunosuppression; infectious complication; infection rate; cytomegalovirus infections
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 13
Issue: 12
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2007-12-01
Start Page: 1487
End Page: 1498
Language: English
DOI: 10.1016/j.bbmt.2007.08.049
PUBMED: 18022579
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 36" - "Export Date: 17 November 2011" - "CODEN: BBMTF" - "Source: Scopus"
Altmetric
Citation Impact
MSK Authors
  1. Nancy Kernan
    477 Kernan