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Blood, Vol. 94 No. 12 (December 15), 1999:
pp. 4029-4035
Increased Incidence of Cytomegalovirus Disease After Autologous
CD34-Selected Peripheral Blood Stem Cell Transplantation
Leona A. Holmberg,
Michael Boeckh,
Heather Hooper,
Wendy Leisenring,
Scott Rowley,
Shelly Heimfeld,
Oliver Press,
David G. Maloney,
Peter McSweeney,
Lawrence Corey,
Richard T. Maziarz,
Frederick R. Appelbaum, and
William Bensinger
From the Clinical Division, Fred Hutchinson Cancer Research Center,
Department of Medicine, University of Washington School of Medicine and
Puget Sound Oncology Consortium, Seattle, WA.
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.
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