Autologous CD34+ enriched peripheral blood progenitor cell (PBPC) transplantation is associated with higher morbidity in patients with lymphoma when compared to unmanipulated PBPC transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 26; no. 8; pp. 831 - 836
• Main Authors: FRIEDMAN, J, LAZARUS, H. M, KOC, O. N
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.10.2000
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD34 - analysis; Autografts; Bacterial diseases; Biological and medical sciences; Blood; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; CD34 antigen; Chemotherapy; Complications; Enrichment; Female; Hematopoietic Stem Cell Transplantation; Hemopoiesis; Humans; Immunology; Infections; Leukocyte Count; Lymphocytes; Lymphoma; Lymphoma - blood; Lymphoma - complications; Lymphoma - therapy; Male; Medical sciences; Middle Aged; Monocytes; Morbidity; Non-Hodgkin's lymphoma; Patients; Peripheral blood; Progenitor cells; Prophylaxis; Statistical analysis; Stem cell transplantation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Autologous; Transplants & implants; Tumors; Enrichment; Human; Stem cell; Hematopoietic cell; Hodgkin disease; Malignant hemopathy; Non Hodgkin lymphoma; Lymphoma; Cell subpopulation; Morbidity; Blood; Infection; Autograft; Treatment; Lymphoproliferative syndrome; Complication; Graft
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1702623

High-dose chemotherapy followed by CD34+ enriched peripheral blood progenitor cell (PBPC) transplantation is used for the treatment of primary refractory or relapsed Hodgkin's and non-Hodgkin's lymphomas. The CD34+ enrichment procedure, while reducing tumor burden, may compromise immunological reconstitution in the transplanted patient and result in increased rates of post-transplant infection. We compared infectious complications in patients with lymphoma who were treated with high-dose chemotherapy and supported either with CD34+ enriched PBPC (n = 19) or unmanipulated PBPCs (n = 24). Analysis was limited to patients discharged from initial hospitalization for transplantation with a minimum of 1 year followup and free of lymphoma recurrence. We found a statistically significant increase in the number of patients with one or more infectious events in the CD34+ transplant group (14/19) compared with the unmanipulated PBPC group (9/24, P < 0.01). Greater numbers of patients with two or more infectious events were observed in the CD34+ group (7/19 vs 2/24, P < 0.03) and an increased incidence of bacterial infections was observed in the CD34+ group (10/19 vs 5/24, P < 0.05). Two deaths due to infectious complications were observed in the CD34+ group. There was no significant difference in blood lymphocyte or monocyte recovery between the groups. These data demonstrate a significant increase in the long-term incidence of infectious events in lymphoma patients transplanted with autologous CD34+ enriched PBPCs compared to unmanipulated PBPCs. Thus, patients who undergo CD34+ enriched PBPC transplantation should be followed closely for infectious complications and prolonged infectious prophylaxis should be considered.