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Tischer, J.* ; Engel, N.* ; Fritsch, S.* ; Prevalsek, D.* ; Hubmann, M.* ; Schulz, C.* ; Zoellner, A.-K.* ; Bücklein, V.L.* ; Reibke, R.* ; Mumm, F.* ; Rieger, C.T.* ; Hill, W.* ; Ledderose, G.* ; Stemmler, H.J.* ; Köhnke, T.* ; Jäger, G.* ; Kolb, H.J.* ; Schmid, C.* ; Moosmann, A. ; Hausmann, A.*

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

Ann. Hematol. 94, 1677-1688 (2015)
DOI
Open Access Gold as soon as Publ. Version/Full Text is submitted to ZB.
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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Publication type Article: Journal article
Document type Scientific Article
Keywords Herpes Virus Infection ; High-dose Cyclophosphamide Posttransplantation ; Hla-haploidentical Hematopoietic Stem Cell Transplantation ; Immune Reconstitution ; T-cell-replete ; Virus Infection; Bone-marrow-transplantation; Versus-host-disease; Identical Sibling Transplantation; Cord Blood Transplantation; Risk Acute-leukemia; Peripheral-blood; Posttransplantation Cyclophosphamide; Hematologic Malignancies; Allogeneic Transplantation; Viral-infections
ISSN (print) / ISBN 0939-5555
e-ISSN 1432-0584
Journal Annals of Hematology
Quellenangaben Volume: 94, Issue: 10, Pages: 1677-1688 Article Number: , Supplement: ,
Publisher Springer
Publishing Place New York
Reviewing status Peer reviewed
Institute(s) CCG Immunooncology (AGV-KIO)