CD34+-selected autologous peripheral blood stem cell transplantation conditioned with total body irradiation for malignant lymphoma: increased risk of infectious complications.
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.
Maeda
S
S
Department of Hematology and Chemotherapy, Nagoya City University School of Medicine, Nagoya, Japan.
Kagami
Y
Y
Ogura
M
M
Taji
H
H
Suzuki
R
R
Kondo
E
E
Asakura
S
S
Takeuchi
T
T
Miura
K
K
Ando
M
M
Nakamura
S
S
Ito
T
T
Kinoshita
T
T
Ueda
R
R
Morishima
Y
Y
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
D018952:Antigens, CD34