Case Report

International Journal of Hematology

, 74:214

First online:

CD34+-Selected Autologous Peripheral Blood Stem Cell Transplantation Conditioned With Total Body Irradiation for Malignant Lymphoma: Increased Risk of Infectious Complications

  • Satoko MaedaAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center Hospital
  • , Yoshitoyo KagamiAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center Hospital
  • , Michinori OguraAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center Hospital
  • , Hirofumi TajiAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center Hospital
  • , Ritsuro SuzukiAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center Hospital
  • , Eisei KondoAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center Hospital
  • , Shouji AsakuraAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center Hospital
  • , Takahiro TakeuchiAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center HospitalSecond Department of Internal Medicine, Nagoya City University School of Medicine
  • , Kazuhisa MiuraAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center HospitalSecond Department of Internal Medicine, Nagoya City University School of Medicine
    • , Manabu AndoAffiliated withDepartment of Clinical Laboratory, Aichi Cancer Center Hospital
    • , Shigeo NakamuraAffiliated withDepartment of Pathology and Genetics, Aichi Cancer Center Hospital
    • , Tatsuya ItoAffiliated withFirst Department of Internal Medicine, Nagoya University School of Medicine
    • , Tomohiro KinoshitaAffiliated withFirst Department of Internal Medicine, Nagoya University School of Medicine
    • , Ryuzo UedaAffiliated withSecond Department of Internal Medicine, Nagoya City University School of Medicine
    • , Yasuo MorishimaAffiliated withDepartment of Hematology and Chemotherapy, Aichi Cancer Center Hospital Email author 

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Abstract

Although high-dose chemotherapy with autologous peripheral blood stem cell transplantation (autoPBSCT) has been shown or confirmed to be an effective treatment for high-risk and relapsed non-Hodgkin’s lymphoma (NHL), relapse after autoPBSCT remains a serious problem. In a clinical trial to overcome relapse, we adopted a treatment plan in which PBSCs purified in vitro to CD34+ cells to deplete tumor cells (CD34+ autoPBSCT), total body irradiation (TBI) of 1200 cGy, and melphalan, 180 mg/m2, were used as a preconditioning regimen. Eighteen patients with relapsed or high-risk NHL participated in the study. This study compared the incidence of complications following CD34+ autoPBSCT preconditioned with the TBI regimen (n = 10): the TBI group; CD34+ autoPBSCT with the non-TBI regimen (n = 8): the non-TBI group; and unselected autoPBSCT with the non-TBI regimen (n = 19): the unselected autoPBSCT control group.After day 30 posttransplantation, 6 of 10 patients treated with the TBI regimen developed 11 infectious complications in total, compared with only 1 of 8 patients treated with the non-TBI regimen and 4 of 19 patients given unselected autoPBSCT.Two fatal complications occurred in the TBI group, but none occurred in the other 2 groups. The CD4+ lymphocyte count at 1 month posttransplantation was significantly lower in the TBI group than in the unse-lected autoPBSCT group.These findings suggest that the addition of TBI to the preconditioning regimen for CD34+ autoPBSCT is associated with an increased incidence of severe infectious complications after transplantation.

Key words

CD34+ cell Autologous peripheral blood stem cell transplantation Lymphoma Total body irradiation Opportunistic infection