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 Graft-versus-Host Disease

Jo Anne H. van Burik, Shelly L. Carter, Alison G. Freifeld, Kevin P. High, Kamar T. Godder, Genovefa A. Papanicolaou, Adam M. Mendizabal, John E. Wagner, Saul Yanovich, Nancy A. Kernan

Research output: Contribution to journalArticlepeer-review

127 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1487-1498
Number of pages12
JournalBiology of Blood and Marrow Transplantation
Volume13
Issue number12
DOIs
StatePublished - Dec 2007

Keywords

  • Aspergillosis
  • Cytomegalovirus
  • Hematopoietic stem cell transplantation
  • T cell depletion

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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