Evaluation of infectious complications and immune recovery following high-dose chemotherapy (HDC) and autologous peripheral blood progenitor cell transplantation (PBPC-T) in 148 breast cancer patients.
OBJECTIVE
High-dose chemotherapy (HDC) with autologous PBPC-T has been reported to be effective in hematological and in selected solid malignancies. In this setting, infectious complications represent a relevant cause of morbidity.


METHODS
To ascertain the incidence, types and factors influencing the development of early and late infections, we retrospectively analyzed 148 consecutive breast cancer (BC) patients receiving HDC and PBPC-T, both for primary high-risk BC (pBC) and metastatic disease (mBC).


RESULTS
Early infection strongly associated with the occurrence of grade 4 mucositis (p < 0.001), was documented in 28 patients (19%). Late re-activation of varicella zoster virus (VZV) occurred in 14 patients (9%); an inverse correlation between the VZV re-activation and the total amount of T-cells transferred with the graft was observed. Evaluation of immune reconstitution, carried out in 10 out of 148 patients, showed a long-lasting CD+ T-cells depression (> 2 year), mainly involving the naive CD4+ T-cell subset. Conversely, the analysis of the frequency of proliferating T-lymphocyte precursors, specific for antigens expressed by 3 different widespread pathogens, demonstrated that, notwithstanding the delayed recovery of CD4+ cells, many T-lymphocyte functions were within normal range 1 year after PBPC-T.


CONCLUSIONS
Altogether these results show that severe mucositis is associated with early bacterial infections and the infusion of large numbers of T-cells plays a role in controlling late VZV reactivation.
Zambelli
Alberto
A
Area Omogenea Oncologica, Divisione di Oncologia Medica, Fondazione Salvatore Maugeri, Clinica del Lavoro e della Riabilitazione (IRCCS), Istituto Scientifico di Pavia, Italy. azambelli@fsm.it
Montagna
Daniela
D
Da Prada
Gian Antonio
GA
Maccario
Rita
R
Zibera
Carlo
C
Moretta
Antonia
A
Ponchio
Luisa
L
Lozza
Laura
L
Baiardi
Paola
P
Maserati
Renato
R
Marone
Pietro
P
Della Cuna
Gioacchino Robustelli
GR
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology* / Q000821:virology; D004305:Dose-Response Relationship, Drug; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000209:etiology* / Q000276:immunology; D016908:Gram-Positive Bacterial Infections / Q000209:etiology* / Q000276:immunology; D006562:Herpes Zoster / Q000209:etiology* / Q000276:immunology; D014645:Herpesvirus 3, Human / Q000502:physiology; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects / Q000276:immunology; D008875:Middle Aged; D009503:Neutropenia / Q000382:microbiology; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D016176:T-Lymphocyte Subsets / Q000187:drug effects / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology; D014775:Virus Activation