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Post-Transplant Events

Paraproteinaemia after allo-SCT, association with alemtuzumab-based conditioning and CMV reactivation

Bone Marrow Transplantation volume 46, pages 993–999 (2011)Cite this article

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Abstract

Paraproteinaemia following allo-SCT is common. We analysed 91 consecutive patients undergoing allo-SCT; conditioning included alemtuzumab in 42% of the patients. Paraproteinaemia incidence at 2 years was 32%. In univariate analysis paraproteinaemia was associated with unrelated donor, age, recipient seropositivity for CMV and alemtuzumab conditioning (hazard ratio (HR) 3.93, P=0.0006). Paraproteinaemia was not associated with haematological diagnosis; disease status at transplant; varicella zoster, herpes simplex or EBV serology; reduced-intensity vs myeloablative conditioning or GVHD. CMV reactivation—more frequent in alemtuzumab recipients—was associated with paraproteinaemia (HR 7.52, P<0.0001). In multivariate analysis, only increasing age (HR 1.04 per year, P=0.048) and CMV reactivation (HR 5.74, P=0.001) were significantly associated with paraproteinaemia. Alemtuzumab without CMV reactivation, however, resulted in significantly more paraproteinaemia, suggesting an effect that is independent of CMV reactivation. OS was poorer in patients with paraproteinaemia (HR 2.54, P=0.04) and relapse increased (HR 2.38, P=0.087). Paraproteinaemia was not significantly independently associated with decreased survival on multivariate analysis. Post transplant paraproteinaemia is associated with CMV reactivation, is more frequent in alemtuzumab-conditioned transplants and is not associated with improved OS.

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Acknowledgements

We would like to thank Kevin Paddon for assistance with laboratory data collection and the staff of the Immunology Laboratory at the Churchill Hospital Oxford for performing serum electrophoresis and immunofixation assays. This work was funded by the NIHR Biomedical Research Centre Programme.

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Authors and Affiliations

  1. Department of Haematology, Oxford Radcliffe Hospitals NHS Trust, Cancer and Haematology Centre, Churchill Hospital, Oxford, UK

    P Medd, S Littlewood, R Malladi, R Clifford, D Wareham, A Peniket & T Littlewood

  2. Nuffield Department of Clinical and Laboratory Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK

    R Danby

  3. Department of Microbiology, John Radcliffe Hospital, Oxford, UK

    K Jeffery

  4. Department of Clinical and Laboratory Immunology, Churchill Hospital, Oxford, UK

    B Ferry

  5. NHS Blood and Transplant Oxford Centre, John Radcliffe Hospital, Oxford, UK

    D Roberts

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  1. P Medd
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Medd, P., Littlewood, S., Danby, R. et al. Paraproteinaemia after allo-SCT, association with alemtuzumab-based conditioning and CMV reactivation. Bone Marrow Transplant 46, 993–999 (2011). https://doi.org/10.1038/bmt.2010.244

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