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Infection in the Hematopoietic Stem Cell Transplant Recipient

  • Lindsey Baden
  • Robert H. Rubin
Chapter
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Part of the Contemporary Hematology book series (CH)

Abstract

Successful hematopoietic stem cell transplantation (HSCT) requires the accomplishment of several tasks: the application of a conditioning regimen that eliminates to the greatest possible extent the patient’ s malignant cell burden; the suppression of the patient’ s immunity in order to prevent rejection of the transplanted cells; and the creation of “space” for the donor cells within the bone marrow. A variety of conditioning regimens are being utilized, with irradiation and chemotherapy (most commonly, cyclophosphamide) being the mainstays of most conditioning regimens. In addition, nonmyeloablative chemotherapy regimens, without irradiation, are being explored as well. These may be supplemented with other chemotherapeutic agents, anti-T-cell antibodies to suppress recipient immunity, and a variety of cytokines and cytokine antagonists. From an infectious disease point of view, the possible consequences of the conditioning regimen are several: mucositis severe enough to affect nutrition and hydration, provide a portal of entry for bacteria and yeast to invade, and prevent the reliable absorption of medications; persistent pancytopenia; and impaired cell-mediated immunity, thus predisposing to viral-induced, especially cytomegalovirus (CMV) infection, as well as Epstein—Barr virus (EBV) posttransplant lymphoproliferative disease (1,2). The importance of granulocytopenia in the pathogenesis of significant infection in patients undergoing treatment for cancer was first defined by Bodey in 1966 (3) and confirmed many times since then. He reported that indidence of infection was 14% if the absolute neutrophil count (ANC) fell below 500/mm3, rising to 24–60% if it fell to less than 100/mm3. The longer the duration of the granulocytopenia and the more rapid the fall in the ANC, the greater the risk of infection. Granulocytopenia of more than 5 wk duration has an incidence of infection that approaches 100% (3–5).

Keywords

Respiratory Syncytial Virus Bloodstream Infection Invasive Aspergillosis Conditioning Regimen Allogeneic Hematopoietic Stem Cell Transplantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Lindsey Baden
  • Robert H. Rubin

There are no affiliations available

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