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dc.contributor.authorChakrabarti, Suparno
dc.contributor.authorMackinnon, Stephen
dc.contributor.authorChopra, Rajesh
dc.contributor.authorKottaridis, Panagiotis D
dc.contributor.authorPeggs, Karl S
dc.contributor.authorO'Gorman, Peter
dc.contributor.authorChakraverty, Ronjon
dc.contributor.authorMarshall, Timothy
dc.contributor.authorOsman, Husam
dc.contributor.authorMahendra, Premini
dc.contributor.authorCraddock, Charles
dc.contributor.authorWaldmann, Herman
dc.contributor.authorHale, Geoff
dc.contributor.authorFegan, Christopher D
dc.contributor.authorYong, Kwee
dc.contributor.authorGoldstone, Anthony H
dc.contributor.authorLinch, David C
dc.contributor.authorMilligan, Donald W
dc.date.accessioned2009-09-08T08:57:06Z
dc.date.available2009-09-08T08:57:06Z
dc.date.issued2002-06-15
dc.identifier.citationHigh incidence of cytomegalovirus infection after nonmyeloablative stem cell transplantation: potential role of Campath-1H in delaying immune reconstitution. 2002, 99 (12):4357-63 Blooden
dc.identifier.issn0006-4971
dc.identifier.pmid12036862
dc.identifier.doi10.1182/blood.V99.12.4357
dc.identifier.urihttp://hdl.handle.net/10541/80214
dc.description.abstractNonmyeloablative 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.
dc.language.isoenen
dc.subjectCancer Antibodiesen
dc.subjectHaematologic Canceren
dc.subjectHaematopoietic Stem Cell Transplantationen
dc.subject.meshAdolescent
dc.subject.meshAdult
dc.subject.meshAntibodies, Monoclonal
dc.subject.meshAntibodies, Neoplasm
dc.subject.meshAntineoplastic Agents
dc.subject.meshCytomegalovirus
dc.subject.meshCytomegalovirus Infections
dc.subject.meshFemale
dc.subject.meshHematologic Neoplasms
dc.subject.meshHematopoietic Stem Cell Transplantation
dc.subject.meshHumans
dc.subject.meshImmune System
dc.subject.meshIncidence
dc.subject.meshLymphocyte Count
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshSurvival Analysis
dc.subject.meshTransplantation Conditioning
dc.subject.meshVirus Activation
dc.titleHigh incidence of cytomegalovirus infection after nonmyeloablative stem cell transplantation: potential role of Campath-1H in delaying immune reconstitution.en
dc.typeArticleen
dc.contributor.departmentDepartment of Haematology, Birmingham Heartlands Hospital, University of Birmingham, Birmingham, United Kingdom.en
dc.identifier.journalBlooden
html.description.abstractNonmyeloablative 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.


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