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    High incidence of cytomegalovirus infection after nonmyeloablative stem cell transplantation: potential role of Campath-1H in delaying immune reconstitution.

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    Authors
    Chakrabarti, Suparno
    Mackinnon, Stephen
    Chopra, Rajesh
    Kottaridis, Panagiotis D
    Peggs, Karl S
    O'Gorman, Peter
    Chakraverty, Ronjon
    Marshall, Timothy
    Osman, Husam
    Mahendra, Premini
    Craddock, Charles
    Waldmann, Herman
    Hale, Geoff
    Fegan, Christopher D
    Yong, Kwee
    Goldstone, Anthony H
    Linch, David C
    Milligan, Donald W
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    Affiliation
    Department of Haematology, Birmingham Heartlands Hospital, University of Birmingham, Birmingham, United Kingdom.
    Issue Date
    2002-06-15
    
    Metadata
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    Abstract
    Nonmyeloablative conditioning is increasingly used for transplantation in a wide range of diseases, but little is known about its impact on the incidence of infections and immune reconstitution. We examined the pattern and outcome of cytomegalovirus (CMV) infections monitored by polymerase chain reaction-based assays and treated preemptively in 101 patients following nonmyeloablative conditioning containing in vivo Campath-1H. Fifty-one patients (50%) had a CMV infection at a median of 27 days after transplantation with a probability of 84.8% in patients at risk of CMV infection. The probability of recurrence of CMV infection before and after 100 days was 53.6% and 46.6%, respectively, and was more common in unrelated donor transplant recipients. All 3 patients who developed CMV disease died of this complication. The 2 patients with late CMV disease had grade III to IV graft-versus-host-disease (GVHD), which occurred de novo in only 4% of patients and in another 10% following donor lymphocyte infusions. The median time to CD4(+) T-cell count more than 200/microL was 9 months in the 48 patients studied. The probabilities of overall survival and nonrelapse mortality at 18 months were 65% and 27.8%, respectively, with no significant difference in survival between CMV-infected and -uninfected patients. The use of Campath-1H appeared to be associated with a low incidence of GVHD but a high incidence of CMV infections and prolonged immune paresis.
    Citation
    High incidence of cytomegalovirus infection after nonmyeloablative stem cell transplantation: potential role of Campath-1H in delaying immune reconstitution. 2002, 99 (12):4357-63 Blood
    Journal
    Blood
    URI
    http://hdl.handle.net/10541/80214
    DOI
    10.1182/blood.V99.12.4357
    PubMed ID
    12036862
    Type
    Article
    Language
    en
    ISSN
    0006-4971
    ae974a485f413a2113503eed53cd6c53
    10.1182/blood.V99.12.4357
    Scopus Count
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