Evaluation of Opportunistic Infections (OI) with a Novel Combination of Rabbit Anti-Thymocyte Globulin (rA), Sirolimus (S), and Tacrolimus (T) for Graft-versus-Host Disease (GVHD) Prophylaxis in Unrelated Donor Hematopoietic Stem Cell Transplantation (UR-

M. S. RAMESH1, L. LUM 2, M. H. ABIDI 2, L. AYASH 2, V. RATANATHARATHORN 2, J. UBERTI 2, A. MITCHELL 2, P. H. CHANDRASEKAR 1, Z. AL-KADHIMI 2;

Author address: 

1WAYNE STATE Univ., DETROIT, MI, 2KARMANOS CANCER Inst., DETROIT, MI.

Abstract: 

Background: UR-HSCT is frequently associated with GVHD and consequent serious OI. Previously, rA has been shown to be effective as GVHD prophylaxis but with increased risk of OI. Sirolimus containing regimens has been associated with reduced OI. In an ongoing phase II trial of a novel combination regimen containing rA(4.5mg/kg)-S-T for GVHD prophylaxis in UR-HSCT, we evaluated the risk of OI. Methods: Prospective data of infection/GVHD were obtained in 17 patients with underlying hematologic malignancies undergoing UR-HSCT with rA-S-T as GVHD prophylaxis. Results: Median age of study patients was 47 years (range 23-67 years). Median duration of follow up is 3.5 months (range 1-9 months). OI were seen in 6 of 17 patients (cumulative incidence of 0.35 at 9 months) (table). EBV and CMV related infections were asymptomatic viremia, diagnosed by routine surveillance. All infections were mild to moderate in severity and responded to appropriate therapy. Five of 6 patients with infections received systemic corticosteroids for GVHD; the remaining patient had advanced disease and multiple cycles of prior chemotherapy. The cumulative incidence of GVHD was 0.3 at 9 months. Two patients had relapse of underlying disease. There were no deaths. Conclusion: We observed a low frequency and severity of OI with rA-T-S regimen in UR-HSCT. The use of steroids may contribute to OI.
2009

abstract No: 

V-1738

Full conference title: 

49th Annual ICAAC
    • ICAAC 49th