title: CD34+-selected autologous peripheral blood stem cell transplantation conditioned with total body irradiation for malignant lymphoma: increased risk of infectious complications.
abstract: Although high-dose chemotherapy with autologous peripheral blood stem cell transplantation (autoPBSCT) has been shown or confirmed to be an effective treatment for high-risk and relapsed non-Hodgkin's lymphoma (NHL), relapse after autoPBSCT remains a serious problem. In a clinical trial to overcome relapse, we adopted a treatment plan in which PBSCs purified in vitro to CD34+ cells to deplete tumor cells (CD34+ autoPBSCT), total body irradiation (TBI) of 1200 cGy, and melphalan, 180 mg/m2, were used as a preconditioning regimen. Eighteen patients with relapsed or high-risk NHL participated in the study. This study compared the incidence of complications following CD34+ autoPBSCT preconditioned with the TBI regimen (n = 10): the TBI group; CD34+ autoPBSCT with the non-TBI regimen (n = 8): the non-TBI group; and unselected autoPBSCT with the non-TBI regimen (n = 19): the unselected autoPBSCT control group. After day 30 posttransplantation, 6 of 10 patients treated with the TBI regimen developed 11 infectious complications in total, compared with only 1 of 8 patients treated with the non-TBI regimen and 4 of 19 patients given unselected autoPBSCT. Two fatal complications occurred in the TBI group, but none occurred in the other 2 groups. The CD4+ lymphocyte count at 1 month posttransplantation was significantly lower in the TBI group than in the unselected autoPBSCT group. These findings suggest that the addition of TBI to the preconditioning regimen for CD34+ autoPBSCT is associated with an increased incidence of severe infectious complications after transplantation.
authors.affiliation: Department of Hematology and Chemotherapy, Nagoya City University School of Medicine, Nagoya, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Maeda
authors.forename: Y
authors.initials: Y
authors.lastname: Kagami
authors.forename: M
authors.initials: M
authors.lastname: Ogura
authors.forename: H
authors.initials: H
authors.lastname: Taji
authors.forename: R
authors.initials: R
authors.lastname: Suzuki
authors.forename: E
authors.initials: E
authors.lastname: Kondo
authors.forename: S
authors.initials: S
authors.lastname: Asakura
authors.forename: T
authors.initials: T
authors.lastname: Takeuchi
authors.forename: K
authors.initials: K
authors.lastname: Miura
authors.forename: M
authors.initials: M
authors.lastname: Ando
authors.forename: S
authors.initials: S
authors.lastname: Nakamura
authors.forename: T
authors.initials: T
authors.lastname: Ito
authors.forename: T
authors.initials: T
authors.lastname: Kinoshita
authors.forename: R
authors.initials: R
authors.lastname: Ueda
authors.forename: Y
authors.initials: Y
authors.lastname: Morishima
mesh_terms: D000328:Adult; D018952:Antigens, CD34; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D006801:Humans; D007239:Infections / Q000209:etiology*; D008223:Lymphoma / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000379:methods / Q000592:standards; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000009:adverse effects* / Q000592:standards
chemical_list: D018952:Antigens, CD34