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Erschienen in: Annals of Hematology 10/2015

01.10.2015 | Original Article

Virus infection in HLA-haploidentical hematopoietic stem cell transplantation: incidence in the context of immune recovery in two different transplantation settings

verfasst von: Johanna Tischer, Nicole Engel, Susanne Fritsch, Dusan Prevalsek, Max Hubmann, Christoph Schulz, Anna-K. Zoellner, Veit Bücklein, Roland Reibke, Friederike Mumm, Christina T. Rieger, Wolfgang Hill, Georg Ledderose, Hans Joachim Stemmler, Thomas Köhnke, Gundula Jäger, Hans Jochem Kolb, Christoph Schmid, Andreas Moosmann, Andreas Hausmann

Erschienen in: Annals of Hematology | Ausgabe 10/2015

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Abstract

We retrospectively compared the incidence of virus infections and outcome in the context of immune reconstitution in two different HLA-haploidentical transplantation (haplo-HSCT) settings. The first was a combined T-cell-replete and T-cell-deplete approach using antithymocyte globulin (ATG) prior to transplantation in patients with hematological diseases (cTCR/TCD group, 28 patients; median age 31 years). The second was a T-cell-replete (TCR) approach using high-dose posttransplantation cyclophosphamide (TCR/PTCY group, 27 patients; median age 43 years). The incidence of herpesvirus infection was markedly lower in the TCR/PTCY (22 %) than in the cTCR/TCD group (93 %). Recovery of CD4+ T cells on day +100 was faster in the TCR/PTCY group. CMV reactivation was 30 % in the TCR/PTCY compared to 57 % in the cTCR/TCD group, and control with antiviral treatment was superior after TCR/PTCY transplantation (100 vs 50 % cTCR/TCD). Twenty-five percent of the patients in the cTCR/TCD group but no patient in the TCR/PTCY group developed PTLD. While 1-year OS was not different (TCR/PTCY 59 % vs cTCR/TCD 39 %; p = 0.28), virus infection-related mortality (VIRM) was significantly lower after TCR/PTCY transplantation (1-year VIRM, 0 % TCR/PTCY vs 29 % cTCR/TCD; p = 0.009). On day +100, predictors of better OS were lymphocytes >300/μl, CD3+ T cells >200/μl, and CD4+ T cells >150/μl, whereas the application of steroids >1 mg/kg was correlated with worse outcome. Our results suggest that by presumably preserving antiviral immunity and allowing fast immune recovery of CD4+ T cells, the TCR approach using posttransplantation cyclophosphamide is well suited to handle the important issue of herpesvirus infection after haplo-HSCT.
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Metadaten
Titel
Virus infection in HLA-haploidentical hematopoietic stem cell transplantation: incidence in the context of immune recovery in two different transplantation settings
verfasst von
Johanna Tischer
Nicole Engel
Susanne Fritsch
Dusan Prevalsek
Max Hubmann
Christoph Schulz
Anna-K. Zoellner
Veit Bücklein
Roland Reibke
Friederike Mumm
Christina T. Rieger
Wolfgang Hill
Georg Ledderose
Hans Joachim Stemmler
Thomas Köhnke
Gundula Jäger
Hans Jochem Kolb
Christoph Schmid
Andreas Moosmann
Andreas Hausmann
Publikationsdatum
01.10.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Annals of Hematology / Ausgabe 10/2015
Print ISSN: 0939-5555
Elektronische ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-015-2423-y

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