Higher risk of cytomegalovirus and aspergillus infections in recipients of T cell-depleted unrelated bone marrow: analysis of infectious complications in patients treated with T cell depletion versus immunosuppressive therapy to prevent graft-versus-host disease

Biol Blood Marrow Transplant. 2007 Dec;13(12):1487-98. doi: 10.1016/j.bbmt.2007.08.049.


Serious infections are a major obstacle limiting the usefulness of unrelated donor marrow transplantation. Graft-versus-host disease (GVHD) and its therapy are associated with a high risk of opportunistic infection. In this study, patients were randomized to receive 1 of 2 GVHD prophylaxis strategies, marrow T cell depletion, and cyclosporine (TCD) or methotrexate/cyclosporine (M/C) after transplantation. The patients underwent transplantation between March 1995 and October 2000 as part of a multicenter randomized trial. As a secondary analysis, we analyzed infections in this study cohort. Among the 404 patients who underwent transplantation, a total of 1598 infections were reported. The rates of serious and fatal infections did not differ between the TCD and M/C groups. Bacterial infections accounted for 1/3 of serious infections in each treatment arm. A significantly higher incidence of severe cytomegalovirus (CMV) and life-threatening or fatal aspergillus infections was observed in the patients receiving TCD (CMV, 28% vs 17% [P = .02]; aspergillosis, 16% vs 7% [P < .01]). The only independent risk factor for serious infection was the development of grade III-IV acute GVHD (aGVHD; hazard ratio = 1.41; 95% confidence interval = 1.03-1.91). Strategies to speed immune recovery, even in the absence of GVHD, are needed to overcome the risk of infection after unrelated donor transplantation.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aspergillosis*
  • Bone Marrow Transplantation* / adverse effects
  • Bone Marrow Transplantation* / methods
  • Cohort Studies
  • Cyclosporine / therapeutic use
  • Cytomegalovirus Infections / epidemiology*
  • Female
  • Graft vs Host Disease / complications
  • Graft vs Host Disease / prevention & control
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Hematopoietic Stem Cell Transplantation* / methods
  • Humans
  • Immunosuppression Therapy / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Lymphocyte Depletion / adverse effects*
  • Male
  • Methotrexate / therapeutic use
  • Opportunistic Infections / epidemiology*
  • Retrospective Studies
  • Survival Analysis
  • Transplantation, Homologous / adverse effects


  • Immunosuppressive Agents
  • Cyclosporine
  • Methotrexate