title: Increased incidence of cytomegalovirus disease after autologous CD34-selected peripheral blood stem cell transplantation.
abstract: High-dose therapy with autologous peripheral blood stem cell (PBSC) rescue is widely used for the treatment of malignant disease. CD34 selection of PBSC has been applied as a means of reducing contamination of the graft. Although CD34 selection results in a 2 to 3 log reduction in contaminating tumor cells without significantly delaying engraftment, many other types of cells are depleted from the CD34-enriched grafts and immune reconstitution may be impaired. In the present study, 31 cytomegalovirus (CMV)-seropositive patients who received myeloablative therapy followed by the infusion of CD34-selected autologous PBSC were assessed for the development of CMV disease in the first 100 days posttransplant. Seven patients (22.6%) developed CMV disease and 4 patients (12.9%) died from complications of their infection. In a contemporaneous group of 237 CMV-seropositive patients receiving unselected, autologous PBSC, only 10 patients (4.2%) developed CMV disease, with 5 deaths (2.1%). In a multivariate logistic regression analysis, the use of CD34-selected autologous PBSC after high-dose therapy was associated with a marked increase in the incidence of CMV disease and CMV-associated deaths.
authors.affiliation: Clinical Division, Fred Hutchinson Cancer Research Center, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Holmberg
authors.forename: M
authors.initials: M
authors.lastname: Boeckh
authors.forename: H
authors.initials: H
authors.lastname: Hooper
authors.forename: W
authors.initials: W
authors.lastname: Leisenring
authors.forename: S
authors.initials: S
authors.lastname: Rowley
authors.forename: S
authors.initials: S
authors.lastname: Heimfeld
authors.forename: O
authors.initials: O
authors.lastname: Press
authors.forename: D G
authors.initials: DG
authors.lastname: Maloney
authors.forename: P
authors.initials: P
authors.lastname: McSweeney
authors.forename: L
authors.initials: L
authors.lastname: Corey
authors.forename: R T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: W
authors.initials: W
authors.lastname: Bensinger
mesh_terms: D000293:Adolescent; D000328:Adult; D018952:Antigens, CD34; D001327:Autoimmune Diseases / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000209:etiology*; D005260:Female; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D014182:Transplantation, Autologous / Q000009:adverse effects
chemical_list: D018952:Antigens, CD34