Evaluation of infectious complications and immune recovery following high-dose chemotherapy (HDC) and autologous peripheral blood progenitor cell transplantation (PBPC-T) in 148 breast cancer patients.

BACKGROUND AND

OBJECTIVES

High-dose chemotherapy (HDC) with autologous PBPC-T has been reported to be effective in hematological and in selected solid malignancies. In this setting, infectious complications represent a relevant cause of morbidity.

PATIENTS AND

METHODS

To ascertain the incidence, types and factors influencing the development of early and late infections, we retrospectively analyzed 148 consecutive breast cancer (BC) patients receiving HDC and PBPC-T, both for primary high-risk BC (pBC) and metastatic disease (mBC).

RESULTS

Early infection strongly associated with the occurrence of grade 4 mucositis (p < 0.001), was documented in 28 patients (19%). Late re-activation of varicella zoster virus (VZV) occurred in 14 patients (9%); an inverse correlation between the VZV re-activation and the total amount of T-cells transferred with the graft was observed. Evaluation of immune reconstitution, carried out in 10 out of 148 patients, showed a long-lasting CD+ T-cells depression (> 2 year), mainly involving the naive CD4+ T-cell subset. Conversely, the analysis of the frequency of proliferating T-lymphocyte precursors, specific for antigens expressed by 3 different widespread pathogens, demonstrated that, notwithstanding the delayed recovery of CD4+ cells, many T-lymphocyte functions were within normal range 1 year after PBPC-T.

CONCLUSION

Altogether these results show that severe mucositis is associated with early bacterial infections and the infusion of large numbers of T-cells plays a role in controlling late VZV reactivation.