Higher risk of cytomegalovirus and aspergillus infections in recipients of T cell-depleted unrelated bone marrow: analysis of infectious complications in patients treated with T cell depletion versus immunosuppressive therapy to prevent graft-versus-host disease.
Serious infections are a major obstacle limiting the usefulness of unrelated donor marrow transplantation. Graft-versus-host disease (GVHD) and its therapy are associated with a high risk of opportunistic infection. In this study, patients were randomized to receive 1 of 2 GVHD prophylaxis strategies, marrow T cell depletion, and cyclosporine (TCD) or methotrexate/cyclosporine (M/C) after transplantation. The patients underwent transplantation between March 1995 and October 2000 as part of a multicenter randomized trial. As a secondary analysis, we analyzed infections in this study cohort. Among the 404 patients who underwent transplantation, a total of 1598 infections were reported. The rates of serious and fatal infections did not differ between the TCD and M/C groups. Bacterial infections accounted for 1/3 of serious infections in each treatment arm. A significantly higher incidence of severe cytomegalovirus (CMV) and life-threatening or fatal aspergillus infections was observed in the patients receiving TCD (CMV, 28% vs 17% [P = .02]; aspergillosis, 16% vs 7% [P < .01]). The only independent risk factor for serious infection was the development of grade III-IV acute GVHD (aGVHD; hazard ratio = 1.41; 95% confidence interval = 1.03-1.91). Strategies to speed immune recovery, even in the absence of GVHD, are needed to overcome the risk of infection after unrelated donor transplantation.
van Burik
Jo-Anne H
JA
Department of Pediatrics and Medicine, University of Minnesota, Minneapolis, Minnesota, USA. vanbu004@umn.edu
Carter
Shelly L
SL
Freifeld
Alison G
AG
High
Kevin P
KP
Godder
Kamar T
KT
Papanicolaou
Genovefa A
GA
Mendizabal
Adam M
AM
Wagner
John E
JE
Yanovich
Saul
S
Kernan
Nancy A
NA
D000293:Adolescent; D000328:Adult; D001228:Aspergillosis; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D016572:Cyclosporine / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008212:Lymphocyte Depletion / Q000009:adverse effects*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008727:Methotrexate