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Infectious complications after allogeneic bone marrow transplantation with and without T-cell depletion of donor marrow

Infektiöse Komplikationen nach allogener Knochenmarktransplantation mit und ohne T-Zell-Depletion des Spendermarkes

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Summary

The infectious complications during different time intervals after allogeneic bone marrow transplantation (BMT) (day 0 to day 30, 31 to 100, 101 to 365, 366 to 730) were reviewed in 67 adult patients, 27 of whom received transplants without T-cell depletion (TCD) using methotrexate or cyclosporin A for prophylaxis of graft-versus-host disease (GvHD) and 40 of whom received donor marrow with TCD using the monoclonal anti-lymphocyte antibody campath-1 and human complement. The use of TCD reduced the incidence and severity of GvHD significantly (p<0.01), but was associated with an increased rate of graft rejections. During all time intervals patients with TCD had a similar, lower or statistically significantly lower number of bacterial, fungal or viral infections and a statistically significantly lower number of lethal infections (p=0.05) as compared with patients without TCD. This finding might be explained by the fact that with TCD immunological reconstitution can take place unimpaired by GvHD or its prophylaxis or treatment, resulting in a decreased incidence of infections.

Zusammenfassung

Bei 67 erwachsenen Patienten wurden die Infektkomplikationen nach allogener Knochenmarktransplantation (KMT) während verschiedener Zeitintervalle (Tag 0 bis Tag 30, 31 bis 100, 101 bis 365, 366 bis 730) untersucht. Siebenundzwanzig Patienten erhielten ein Transplantat ohne T-Zell-Depletion (TCD) unter Verwendung von Methotrexat oder Cyclosporin A als Prophylaxe einer Graftversus-Host-Reaktion (GvHD) und 40 Patienten ein Transplantat mit TCD durch Einsatz des monoklonalen Lymphozyten-Antikörpers Campath-1 und humanem Komplement. Die TCD verminderte Häufigkeit und Schweregrad der GvHD signifikant (p<0.01), war aber mit einer erhöhten Transplantatabstoßung verknüpft. Während der verschiedenen Zeitintervalle hatten Patienten mit TCD eine ähnliche, niedrigere oder statistisch signifikant niedrigere Anzahl von bakteriellen, mykotischen oder viralen Infektionen und außerdem eine statistisch signifikant niedrigere Anzahl von tödlichen Infektionen (p=0.05) im Vergleich zu Patienten ohne TCD.

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  1. Abteilung für Innere Medizin III (Hämotologie, Onkologie, Infektionskrankheiten), Universität Ulm, D-7900, Ulm

    T. Schmeiser,  M. Wiesneth,  D. Bunjes P.D.,  Renate Arnold,  B. Hertenstein,  W. Heit &  E. Kurrte

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  1. T. Schmeiser
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Schmeiser, T., Wiesneth, M., Bunjes, D. et al. Infectious complications after allogeneic bone marrow transplantation with and without T-cell depletion of donor marrow. Infection 17, 124–130 (1989). https://doi.org/10.1007/BF01644010

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