title: A comparison of postengraftment infectious morbidity and mortality after allogeneic partially T cell-depleted peripheral blood progenitor cell transplantation versus T cell-depleted bone marrow transplantation.
abstract: OBJECTIVE
  Postengraftment infections are a major cause of transplant-related morbidity and mortality following allogeneic hematopoietic stem cell transplantation (allo-SCT). Allogeneic peripheral blood progenitor cell transplantation (PBPCT) is associated with faster hematopoietic recovery compared to bone marrow transplantation (BMT) and unmanipulated PBPCT may be associated with fewer postengraftment infections. We set out to evaluate and compare the incidence, cause, and outcome of postengraftment infections following HLA-identical sibling T cell-depleted PBPCT vs T cell-depleted BMT between days 30 and 365 posttransplant.
  
  
  METHODS
  Forty recipients of peripheral blood progenitor cells (PBPC) and 47 recipients of bone marrow (BM) were included. The two groups of patients were comparable with respect to their baseline characteristics.
  
  
  RESULTS
  PBPC grafts contained significantly more CD34+ cells and PBPCT was associated with significantly faster neutrophil and lymphocyte recovery as compared to BMT. PBPC recipients experienced more chronic graft-vs-host disease (GVHD; 55% vs 34%; p=0.02). The number of definite and clinical infections per 100 patient days was comparable between recipients of PBPC and BM with similar contribution of causative microorganisms. At one year post SCT, 68% of PBPC recipients had experienced at least one CTC grade 3-4 infection vs 65% of BM recipients. Treatment-related mortality at one year from transplantation was 34% after PBPCT vs 30% after BMT, and no difference in infection-related mortality was observed.
  
  
  CONCLUSIONS
  Postengraftment infectious morbidity and mortality were comparable between recipients of PBPC and BM despite a higher CD34+ cell content of PBPC grafts and faster lymphocyte recovery after PBPCT, which may in part be explained by the higher incidence of chronic GVHD.
authors.affiliation: Department of Hematology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Annoek E C
authors.initials: AE
authors.lastname: Broers
authors.forename: Bronno
authors.initials: B
authors.lastname: van der Holt
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Haze
authors.forename: Eric
authors.initials: E
authors.lastname: Braakman
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Gratama
authors.forename: Bob
authors.initials: B
authors.lastname: Löwenberg
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000209:etiology / Q000401:mortality*; D016026:Bone Marrow Transplantation / Q000401:mortality*; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000401:mortality; D006402:Hematologic Diseases / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D008212:Lymphocyte Depletion / Q000379:methods; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality*; D020127:Recovery of Function; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000473:pathology; D014777:Virus Diseases / Q000209:etiology / Q000401:mortality*