Increased Incidence of Cytomegalovirus Disease After Autologous CD34-Selected Peripheral Blood Stem Cell Transplantation

Abstract

High-dose therapy with autologous peripheral blood stem cell (PBSC) rescue is widely used for the treatment of malignant disease. CD34 selection of PBSC has been applied as a means of reducing contamination of the graft. Although CD34 selection results in a 2 to 3 log reduction in contaminating tumor cells without significantly delaying engraftment, many other types of cells are depleted from the CD34-enriched grafts and immune reconstitution may be impaired. In the present study, 31 cytomegalovirus (CMV)-seropositive patients who received myeloablative therapy followed by the infusion of CD34-selected autologous PBSC were assessed for the development of CMV disease in the first 100 days posttransplant. Seven patients (22.6%) developed CMV disease and 4 patients (12.9%) died from complications of their infection. In a contemporaneous group of 237 CMV-seropositive patients receiving unselected, autologous PBSC, only 10 patients (4.2%) developed CMV disease, with 5 deaths (2.1%). In a multivariate logistic regression analysis, the use of CD34-selected autologous PBSC after high-dose therapy was associated with a marked increase in the incidence of CMV disease and CMV-associated deaths.

Cytomegalovirus infection in hematologic malignancy settings other than the allogeneic transplant

“…40,41 Subsequently, other reports confirmed the relevance of this issue, although reporting a variable rate of incidence ranging between 30 to 40% and 1 to 13%, according to different diagnostic strategies. 5,[42][43][44][45][46][47][48][49] Even though all these studies showed a significant reactivation rate of CMV infection in patients undergoing ASCT, CMV disease was a rare event, although representing a serious life-threatening risk, with a clinical course and mortality rates similar to those observed after allo-HSCT. 1 3,7,8,39,52,[54][55][56][57][58][59] Of note, overt CMV disease incidence and mortality appear similar irrespective to the diagnostic strategy adopted, further suggesting the limited usefulness of a prospective monitoring of CMV infection.…”

Evaluation of risk of symptomatic cytomegalovirus reactivation in myeloma patients treated with tandem autologous stem cell transplantation and novel agents: a single‐institution study

“…In fact, previous observations, over the last 10-15 years, suggested an incidence of CMV reactivations, based on routine monitoring by polymerase chain reaction (PCR)/antigenemia CMV, of between 30% and 40% of subjects presenting with either lymphoma or MM. However, the incidence decreases to 1-13% when CMV determination was performed only on the basis of clinical signs pointing to a clinical suspicion of CMV infection (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In addition, most studies performed have considered single, rather than tandem, transplantation.…”

Large‐scale expansion and transplantation of CD34+ hematopoietic cells: in vitro and in vivo confirmation of neutropenia abrogation related to the expansion process without impairment of the long‐term engraftment capacity

“…7,8 This has sometimes been related to an increase in the morbidity of the procedure. 9,10 The ex vivo culture of HPCs with various combinations of cytokines can increase the number of colonyforming unit-granulocyte-macrophage (CFU-GM) and CD34+ cells. 11 In vivo studies in baboons have shown that expanded CD34+ cells can substantially reduce neutropenia after myeloablation.…”