Forty-nine children who received peripheral blood stem cell autografts (PBSCT) were observed for the development of transfusion-related disease (TRD), including cytomegalovirus (CMV) disease, alloimmunization, and graft-versus-host disease (GVHD). Cytoreductive regimens did not include total body irradiation. A comprehensive prophylactic strategy including alkylated hyperimmune CMV globulin and filtered, nonirradiated, leukocyte-poor blood products was applied. Two patients showed temporary refractoriness to platelet transfusion, but none suffered from symptomatic CMV infection or GVHD. Thus, under these conditions the incidence of TRD appears to be low in children undergoing PBSCT.