In vivo/ex vivo T cell depletion for GVHD prophylaxis influences onset and course of active cytomegalovirus infection and disease after BMT.
Combined in vivo/ex vivo T cell depletion is effective in the prophylaxis of graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation (BMT), but influences the occurrence of active cytomegalovirus (CMV) infection and disease. Twenty nine patients receiving a T cell-depleted marrow graft (Campath-1M) after intravenous application of the monoclonal antibody Campath-1G prior to conditioning were monitored for virus shedding and antigenaemia from day -7 to day +100. In seropositive patients in this group active CMV infection occurred more frequently (10 of 16) and much earlier (nine of 10 until day +21) than in 27 seropositive patients (10 of 27, P < 0.02) receiving cyclosporin A and methotrexate (CsA/MTX). Early active CMV infection after in vivo/ex vivo T cell depletion correlated strictly with an early increase in blood lymphocyte counts (P < 0.01), with predominance of NK cells and/or CD8+ T cells. Three cases of very early interstitial pneumonitis (IP) occurred after in vivo/ex vivo T cell depletion compared with none in the CsA/MTX group. IP was fatal in the only patient with early active CMV infection, who remained lymphocytopenic till death on day +31. This may indicate that an early immune response against CMV is possible and essential for favourable clinical outcome.
Hertenstein
B
B
Department of Internal Medicine III, University of Ulm, Germany.
Hampl
W
W
Bunjes
D
D
Wiesneth
M
M
Duncker
C
C
Koszinowski
U
U
Heimpel
H
H
Arnold
R
R
Mertens
T
T
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D016572:Cyclosporine / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D015994:Incidence; D008212:Lymphocyte Depletion; D008218:Lymphocytosis / Q000209:etiology*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000209:etiology; D013601:T-Lymphocytes; D014184:Transplantation, Homologous
D016572:Cyclosporine; D008727:Methotrexate