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Blood, 15 February 2002, Vol. 99, No. 4, pp. 1486-1488
BRIEF REPORT
Unusual viral infections (progressive multifocal
leukoencephalopathy and cytomegalovirus disease) after high-dose
chemotherapy with autologous blood stem cell rescue and
peritransplantation rituximab
Stuart L. Goldberg,
Andrew L. Pecora,
Robert S. Alter,
Mark S. Kroll,
Scott D. Rowley,
Stanley E. Waintraub,
Kavita Imrit, and
Robert A. Preti
From the Adult Blood and Marrow Transplantation
Program, Hackensack University Medical Center, NJ; Centra State Medical
Center, Freehold, NJ; and Progenitor Cell Therapy, Hackensack, NJ.
Efforts to reduce relapse of non-Hodgkin lymphoma after autologous
transplantation have included ex vivo stem cell selection and/or
peritransplantation immunotherapy. The late infectious and immunologic
consequences of these maneuvers are not well understood, although an
increase in early cytomegaloviral disease after CD34+ stem
cell selection and an alteration in immunoglobulin and T-cell recovery
after peritransplantation rituximab has been noted. We report the first
2 cases of progressive multifocal leukoencephalopathy caused by
JC papovavirus after autologous peripheral blood stem cell
transplantation and a case each of cytomegalovirus retinitis and
pneumonitis. All 4 patients experienced significant impairment of CD4
T-cell recovery, placing them at risk for these unusual viral
infections. The clustering of cases is concerning because all occurred
shortly after the introduction of peritransplantation rituximab into
treatment protocols (4 of 62 immunotherapy recipients compared
with 0 of 276 without; z = 3.595;
P < .001), although a direct association with this CD20
B-cell-directed therapy remains speculative.
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