Seropositivity for cytomegalovirus in patients underwent peripheral blood stem cell transplantation from unrelated donors reduces overall survival comparable to patients underwent marrow transplantation.

IW Blau, MD, N. Basara, MD, B. Schmetzer, PhD, E. Roemer, MD, S. Günzelmann, MD, M. G. Kiehl, MD A. A. Fauser MD, PhD

Clinic of BMT and Hem./Oncol., Idar-Oberstein, Germany.

Aim: We have compared the outcomes in patients receiving unrelated peripheral blood stem cell transplants (PBSCT) with those receiving bone marrow transplants (BMT) in a matched pair analysis. Patients and Methods: Seventy eight patients with hematological malignancies with HLA-matched (77%) and mismatched (23%) donors were analyzed in this study. Thirty four patients (45%) were considered as high risk patients. Sixty eight patients received standard conditioning regimen with Bu/Cy or TBI/Cy. Six patients received an intensified conditioning regimen with addition of etoposide, thiotepa or melphalan. The GvHD prophylaxis regimen consisted of prednisolone, cyclosporine and methotrexate. Groups were matched for patient, donor, transplant characteristics and HLA-compatibility. Results: Peripheral blood stem cell collection led to the collection of a higher number of CD34+ (4,0 x 106/kgBW in PBSC group and 2,5 x 106/kgBW in BM group) and CD3+ cells ( 284 x 106/kgBW and 24,6 x 106/kgBW, respectively) in comparison to bone marrow collection. Leukocyte engraftment in PBSCT group occurred in 14 days (median; range 6-26 days) and in the BMT group in 19 days (range 9-29 days; P< 0.02). The patients were not treated with G-CSF posttransplantation. The time of platelet engraftment did not differ significantly. Incidence of grade II-IV acute GVHD in the group of HLA-identical patients not differ in the two groups. In the PBSC group 23/39 patients and in BM group 14/39 patients were positive for CMV-IgG prior to transplantation. The overall survival in the BM group was 42% (with a median of 25 months) and 35% in the PBSC group (with a median 28 months); overall survival in seronegative patients was 55% in the BM group and 65% in the PBSC group. The difference between CMV seropositive and seronegative patients have a trend to be significant (log rank 0.07). Conclusion: These results confirm the poor risk for overall survival for CMV seropositive patients in unrelated BMT. In addition, a comparable risk have been demonstrated for patients underwent unrelated PBSCT.

KEY WORDS: allogeinic PBSCT, CMV-Infection, unrelated marrow donor, GvHD.

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Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Stem Cell Biology.