Summary. The predictable neutropenia that follows allogeneic stem cell transplantation (ASCT) may be associated with recurrence of previous life-threatening infection. We describe nine patients with either previous invasive aspergillosis (IA) or considered to be at high risk of developing IA who underwent ASCT with prophylactic granulocyte transfusions. The study group, when compared with a control group, had a significant reduction in the incidence and duration of fevers (P < 0AE05) and maximum C-reactive protein (P < 0AE05). There were significantly fewer days of neutropenia (P < 0AE05). There was also radiological improvement of pulmonary infiltrates in four out of seven assessable patients. No serious toxicity was encountered in donors or recipients. We conclude that prophylactic granulocyte donations can be given safely, and that they significantly reduce the number of days of neutropenia. Further investigation is warranted to determine whether granulocyte donations can prevent the recurrence of IA in patients at risk of fungal infection.
Summary:We evaluated the outcome of 29 patients (age 22-60 years), who received a CD34+selected related (n ¼ 16) or unrelated graft (n ¼ 13) with limited T-cell addback (TCAB) (median 5.9 Â 10 4 /kg) following full-intensity conditioning for haematological malignancies. In all, 16 patients (55%) had either advanced disease or previous transplants. The cumulative incidences of grade 2-4 acute GVHD were 15.4 and 19.2% and that for chronic extensive GVHD were 35 and 37% in related and unrelated graft recipients, respectively. The strongest predictor of nonrelapse mortality and overall survival was the absolute lymphocyte count (ALC) at 30 days; patients with ALCo0.35 Â 10 9 /l having an NRM and OS of 59.2 and 24.7%, compared to 10 and 90% in those with a higher ALC. Patients with acute leukaemia had poorer survival and this was associated with a lower ALC as well. Thus, TCAB with a CD34+ selected graft resulted in a comparable outcome in both older and younger patients, but the survival was strongly influenced by early lymphocyte recovery.
Summary:We compared the incidence and outcome of preemptively treated cytomegalovirus (CMV) infection, lymphocyte recovery and non-CMV infections between two different TCD modalities, one employing CD34 þ selection and Tcell add-back (TCAB), preceded by Campath-1H in vivo (CD34 þ /TCAB group, n ¼ 29), and the other using grafts incubated with Campath-1H in vitro (Campath-1H in vitro group, n ¼ 32). The probabilities of CMV reactivation and recurrence were 67 and 83.6% in the CD34 þ /TCAB group and 42.9 and 20% in the Campath-1H group (P ¼ 0.07 and 0.02). Donor seropositivity reduced CMV reactivation in the Campath-1H group, but not in the CD34 þ /TCAB group. The durations of positive PCR/antigenemia positivity and antiviral therapy were also significantly longer in the CD34 þ /TCAB group. However, only two patients developed CMV disease in each group. The mean absolute lymphocyte counts ( Â 10 9 /l) at 30 days (0.27 vs 0.4, P ¼ 0.03) and 100 days (0.77 vs 1.4, P ¼ 0.01) were significantly lower in the CD34 þ /TCAB group along with a higher incidence of non-CMV infections in CMV at-risk patients, but not in the CMV low-risk group. These findings suggest that the modality of TCD should be tailored according to the CMV risk status, and CMV sero-positive patients should receive a less extensively Tcell-depleted graft and a CMV sero-positive graft if possible.
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