Infectious complications in patients receiving autologous CD34-selected hematopoietic stem cell transplantation for severe autoimmune diseases.
Long-term analysis of infectious complication after high-dose immunosuppressive therapy with CD34-selected autologous hematopoietic stem cell transplantation for patients with severe autoimmune diseases (AD) was performed. Theoretically, CD34 selection can reduce the risk of reinfusion of autoreactive lymphocytes. However, it is also associated with a significant reduction in T cells, natural killer cells, and monocytes, which in turn may compromise immune reconstitution, thereby increasing the risk of infection. Moreover, AD compromises host immunity and causes organ damage resulting in dysfunction of the cutaneous or mucosal barrier. In this study, the incidence rate of infections is reported in 14 patients who underwent high-dose (200 mg/kg) cyclophosphamide therapy followed by reinfusion of CD34-selected autologous peripheral blood stem cells. Bacterial complication occurred in 3 of 14 (21%) patients. Cytomegalovirus reactivation and adenovirus hemorrhagic cystitis were observed in 9 (64%) and 2 (14%) patients, respectively. As for late infectious complications, 7 patients (50%) developed dermatomal varicella zoster virus infection. No infection-related mortality was seen in this case series. Because the risk for infections approaches that seen in allogeneic transplant recipients, infection surveillance, diagnostic workup, and prophylactic strategies similar to those applicable to allogeneic recipients are warranted.
Kohno
K
K
Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Nagafuji
K
K
Tsukamoto
H
H
Horiuchi
T
T
Takase
K
K
Aoki
K
K
Henzan
H
H
Kamezaki
K
K
Takenaka
K
K
Miyamoto
T
T
Teshima
T
T
Harada
M
M
Akashi
K
K
D000260:Adenoviruses, Human / Q000302:isolation & purification; D000328:Adult; D018952:Antigens, CD34 / Q000378:metabolism*; D001327:Autoimmune Diseases / Q000628:therapy*; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D003587:Cytomegalovirus / Q000302:isolation & purification; D004266:DNA Virus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D005260:Female; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D008089:Listeria monocytogenes / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D034361:Streptococcus mitis / Q000302:isolation & purification; D014182:Transplantation, Autologous / Q000009:adverse effects*; D055815:Young Adult
D018952:Antigens, CD34