CD4+ T lymphocyte counts after autologous transplantation in multiple myeloma: a retrospective study.

The risk for opportunistic infections is correlated with low CD4+ T lymphocyte counts in patients with HIV. We performed a retrospective analysis in 54 patients with multiple myeloma undergoing high-dose melphalan chemotherapy+autologous peripheral blood stem cell transplantation to better define the value of routine control of CD4+ T lymphocyte counts in this important patient group. In 61% of our patients, CD4+ T lymphocyte counts after recovery from neutropenia were < 200/mu l and < 100/mu l in 24% (median 181/mu l). Overall survival, progression-free survival, response to antineoplastic therapy and frequency of post-transplant infections were not significantly different when patients with CD4+ T lymphocyte counts < 200/mu l and > 200/mu l were compared. However, overall survival was significantly shorter in the subgroup of 13 patients with very low CD4+ T lymphocyte counts (< 100/mu l) (P=0.036). In 79.6% of all patients, at least one infection NCI-CTC grade II-IV developed within 100 days post-transplant. Opportunistic infections were rare. This analysis suggests that patients with CD4+ T lymphocyte counts < 100/mu l may have a poorer prognosis.