title: Virus infection in HLA-haploidentical hematopoietic stem cell transplantation: incidence in the context of immune recovery in two different transplantation settings.
abstract: We retrospectively compared the incidence of virus infections and outcome in the context of immune reconstitution in two different HLA-haploidentical transplantation (haplo-HSCT) settings. The first was a combined T-cell-replete and T-cell-deplete approach using antithymocyte globulin (ATG) prior to transplantation in patients with hematological diseases (cTCR/TCD group, 28 patients; median age 31 years). The second was a T-cell-replete (TCR) approach using high-dose posttransplantation cyclophosphamide (TCR/PTCY group, 27 patients; median age 43 years). The incidence of herpesvirus infection was markedly lower in the TCR/PTCY (22 %) than in the cTCR/TCD group (93 %). Recovery of CD4+ T cells on day +100 was faster in the TCR/PTCY group. CMV reactivation was 30 % in the TCR/PTCY compared to 57 % in the cTCR/TCD group, and control with antiviral treatment was superior after TCR/PTCY transplantation (100 vs 50 % cTCR/TCD). Twenty-five percent of the patients in the cTCR/TCD group but no patient in the TCR/PTCY group developed PTLD. While 1-year OS was not different (TCR/PTCY 59 % vs cTCR/TCD 39 %; p = 0.28), virus infection-related mortality (VIRM) was significantly lower after TCR/PTCY transplantation (1-year VIRM, 0 % TCR/PTCY vs 29 % cTCR/TCD; p = 0.009). On day +100, predictors of better OS were lymphocytes >300/μl, CD3+ T cells >200/μl, and CD4+ T cells >150/μl, whereas the application of steroids >1 mg/kg was correlated with worse outcome. Our results suggest that by presumably preserving antiviral immunity and allowing fast immune recovery of CD4+ T cells, the TCR approach using posttransplantation cyclophosphamide is well suited to handle the important issue of herpesvirus infection after haplo-HSCT.
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation, Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Marchioninistr. 15, 81377, Munich, Germany, Johanna.Tischer@med.uni-muenchen.de.
authors.forename: Johanna
authors.initials: J
authors.lastname: Tischer
authors.forename: Nicole
authors.initials: N
authors.lastname: Engel
authors.forename: Susanne
authors.initials: S
authors.lastname: Fritsch
authors.forename: Dusan
authors.initials: D
authors.lastname: Prevalsek
authors.forename: Max
authors.initials: M
authors.lastname: Hubmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Schulz
authors.forename: Anna-K
authors.initials: AK
authors.lastname: Zoellner
authors.forename: Veit
authors.initials: V
authors.lastname: Bücklein
authors.forename: Roland
authors.initials: R
authors.lastname: Reibke
authors.forename: Friederike
authors.initials: F
authors.lastname: Mumm
authors.forename: Christina T
authors.initials: CT
authors.lastname: Rieger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hill
authors.forename: Georg
authors.initials: G
authors.lastname: Ledderose
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Stemmler
authors.forename: Thomas
authors.initials: T
authors.lastname: Köhnke
authors.forename: Gundula
authors.initials: G
authors.lastname: Jäger
authors.forename: Hans Jochem
authors.initials: HJ
authors.lastname: Kolb
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
authors.forename: Andreas
authors.initials: A
authors.lastname: Moosmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Hausmann
mesh_terms: D000293:Adolescent; D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000276:immunology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006680:HLA Antigens