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Viral Infections

Influence of cytomegalovirus (CMV) sero-positivity on CMV infection, lymphocyte recovery and non-CMV infections following T-cell-depleted allogeneic stem cell transplantation: a comparison between two T-cell depletion regimens

Bone Marrow Transplantation volume 33, pages 197–204 (2004)Cite this article

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+ selection and T-cell add-back (TCAB), preceded by Campath-1H in vivo (CD34+/TCAB group, n=29), and the other using grafts incubated with Campath-1H in vitro (Campath-1H in vitro group, n=32). The probabilities of CMV reactivation and recurrence were 67 and 83.6% in the CD34+/TCAB group and 42.9 and 20% in the Campath-1H group (P=0.07 and 0.02). Donor sero-positivity reduced CMV reactivation in the Campath-1H group, but not in the CD34+/TCAB group. The durations of positive PCR/antigenemia positivity and antiviral therapy were also significantly longer in the CD34+/TCAB group. However, only two patients developed CMV disease in each group. The mean absolute lymphocyte counts (× 109/l) at 30 days (0.27 vs 0.4, P=0.03) and 100 days (0.77 vs 1.4, P=0.01) were significantly lower in the CD34+/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 T-cell-depleted graft and a CMV sero-positive graft if possible.

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Authors and Affiliations

  1. Adult Bone Marrow Transplant Unit and Public Health Laboratories, Bristol Royal Hospital for Sick Children, Bristol, UK

    S Chakrabarti, J Brown, I B Vipond, D H Pamphilon & D I Marks

  2. Departments of Haematology and Virology, Birmingham Heartlands Hospital, Birmingham, UK

    S Chakrabarti, D W Milligan & H Osman

Authors
  1. S Chakrabarti
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  2. D W Milligan
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  3. J Brown
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Correspondence to S Chakrabarti.

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Chakrabarti, S., Milligan, D., Brown, J. et al. Influence of cytomegalovirus (CMV) sero-positivity on CMV infection, lymphocyte recovery and non-CMV infections following T-cell-depleted allogeneic stem cell transplantation: a comparison between two T-cell depletion regimens. Bone Marrow Transplant 33, 197–204 (2004). https://doi.org/10.1038/sj.bmt.1704334

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