Frère Pascale, Pereira Maguy, Fillet Georges, Beguin Yves
Division of Hematology, Department of Medicine, University of Liège, Liège, Belgium.
Eur J Haematol. 2006 Feb;76(2):102-8. doi: 10.1111/j.1600-0609.2005.00569.x.
Immune reconstitution may be delayed after CD34-selected compared with unmanipulated autologous peripheral blood stem cell transplantation (PBSCT), resulting in a theoretically increased risk of infections. In a case-control matched study we compared the incidence of infection in 25 recipients of CD34-selected PBSC (CD34 group) and 75 recipients of unmanipulated PBSC (PBSC group) transplants. The population included 52 males and 48 females suffering from non-Hodgkin's lymphoma (n = 32), Hodgkin's disease (n = 8), multiple myeloma (n = 40) or breast cancer (n = 20). Neutrophil engraftment was comparable in the two groups. The actuarial incidence of infection was similar in the two groups (56% vs. 49% at day 30, and 70% vs. 64% at 1 yr respectively). The proportion of patients with 1, 2 or 3 infections, the number of infectious event per patient (1.32 vs. 1.04; NS), the number of infections before day 15 or 30, between days 31 and 100 or after day 100, the risk of varicella-zoster virus or cytomegalovirus infection or disease, or the use of antibiotic or antifungal therapy, were not increased in the CD34 compared with the PBSC group. The main agents responsible for infection were bacteria, particularly gram-positive cocci, in both groups. Bacteremia accounted for 33% of all infectious events in the CD34 group vs. 16% in the PBSC group (P < 0.05). Fungal infections were rare. In conclusion, our results do not support the notion that CD34-selection of the graft is associated with an increased rate of infection after autologous PBSC transplantation. The role of extended infection prophylaxis should be evaluated.
与未处理的自体外周血干细胞移植(PBSCT)相比,CD34选择后的免疫重建可能会延迟,理论上导致感染风险增加。在一项病例对照匹配研究中,我们比较了25例接受CD34选择的PBSC移植受者(CD34组)和75例接受未处理的PBSC移植受者(PBSC组)的感染发生率。研究人群包括52名男性和48名女性,患有非霍奇金淋巴瘤(n = 32)、霍奇金病(n = 8)、多发性骨髓瘤(n = 40)或乳腺癌(n = 20)。两组中性粒细胞植入情况相当。两组感染的精算发生率相似(第30天时分别为56%对49%,1年时分别为70%对64%)。1次、2次或3次感染的患者比例、每位患者的感染事件数量(1.32对1.04;无显著差异)、第15天或30天之前、第31天至100天之间或第100天之后的感染数量、水痘带状疱疹病毒或巨细胞病毒感染或疾病的风险,或抗生素或抗真菌治疗的使用情况,与PBSC组相比,CD34组均未增加。两组中引起感染的主要病原体均为细菌,尤其是革兰氏阳性球菌。CD34组菌血症占所有感染事件的33%,而PBSC组为16%(P < 0.05)。真菌感染很少见。总之,我们的结果不支持以下观点:自体PBSC移植后,移植物的CD34选择与感染率增加有关。应评估延长感染预防措施的作用。