1
|
Revisit of the Association between Cytomegalovirus Infection and Invasive Fungal Infection after Allogeneic Hematopoietic Stem Cell Transplantation: A Real-World Analysis from a High CMV Seroprevalence Area. J Fungi (Basel) 2022; 8:jof8040408. [PMID: 35448639 PMCID: PMC9029330 DOI: 10.3390/jof8040408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022] Open
Abstract
Infection is a major complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT) especially cytomegalovirus (CMV) infection and invasive fungal infection (IFI). Taiwan is a high CMV seroprevalence area. Our study aimed to evaluate the incidence, risk factors, the impact on survival of CMV infection (including reactivation and disease) and the association of CMV infection and IFI in recipients after allo-HSCT during the first 100 days after transplantation. This was a retrospective study including 180 recipients of allo-HSCT. A total of 99 patients had CMV reactivation, and nine patients had CMV diseases. There were more mismatched donors, more ATG usage and more transplantation from CMV IgG-negative donor in patients with CMV reactivation. There was no survival difference in patients with or without CMV reactivation. A total of 34 patients had IFIs, and IFI after allo-HSCT was associated with significantly inferior survival. Patients with CMV reactivation did not increase the incidence of overall IFI, but they did result in more late-onset (>40 days) IFI (p = 0.056). In this study, we demonstrated real-world data of CMV infection and IFI from a high CMV seroprevalence area.
Collapse
|
2
|
Sarina B, Mariotti J, Bramanti S, Morabito L, Crocchiolo R, Rimondo A, Tordato F, Pocaterra D, Casari E, De Philippis C, Carlo-Stella C, Santoro A, Castagna L. A reduced dose of fluconazole as primary antifungal prophylaxis is not associated with increased risk of invasive fungal infections after allogeneic stem cell transplantation from a HLA identical sibling. Transpl Infect Dis 2018; 20:e12906. [PMID: 29668124 DOI: 10.1111/tid.12906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/16/2017] [Accepted: 12/24/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Invasive fungal infections (IFI) represent a common side effect of allogeneic hematopoietic stem cell transplant (allo-SCT), resulting in increased non relapse mortality (NRM) and reduced overall survival (OS) rates. Seventy-five days of Fluconazole 400 mg/d represents the standard primary antifungal prophylaxis (PAP) after allo-SCT, especially for low-risk transplants. However, the ideal dosage of fluconazole has never been tested. METHODS Here, we report the experience of our institution on 113 consecutive patients receiving an allo-SCT from a HLA identical sibling between 1999 and 2015, where PAP consisted of fluconazole 100 mg/d only during the pre-engraftment phase. At the time of transplant, all patients were considered at low-risk for mold infection according to ECIL-5 guidelines. RESULTS Cumulative incidence of possible-probable-proven IFI was 11.7%, while proven-probable (PP-IFI) occurred in 5.5% of patients by day 100 post transplant. Of note, only 1 patient developed invasive Candidiasis due to a non-albicans strain and stool-screening tests were negative for colonization by Candida albicans species. The incidence of 1-year acute and 2-year chronic graft-versus-host-disease (GVHD) was 30% and 45%, respectively. Three-year OS and 1-year NRM were 53% and 11.3%, respectively. CONCLUSION In summary, fungal prophylaxis with fluconazole 100 mg/d results in very low incidence of PP-IFI, GVHD and NRM in low-risk allo-SCT.
Collapse
Affiliation(s)
- Barbara Sarina
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Jacopo Mariotti
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Stefania Bramanti
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Lucio Morabito
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Roberto Crocchiolo
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Andrea Rimondo
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Federica Tordato
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Daria Pocaterra
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Erminia Casari
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Chiara De Philippis
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Carmelo Carlo-Stella
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Armando Santoro
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Luca Castagna
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| |
Collapse
|
3
|
Ma J, Hu Y, Wu M, Wang X, Xie Y. Timing Determination of Invasive Fungal Infection Prophylaxis According to Immune Function in HSCT Patients. Front Microbiol 2018; 9:370. [PMID: 29552004 PMCID: PMC5840169 DOI: 10.3389/fmicb.2018.00370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/16/2018] [Indexed: 11/28/2022] Open
Abstract
Patients who receive a hematopoietic stem cell transplantation (HSCT) exhibit an immune defect after recovering from neutropenia. The current guidelines do not recommend fungal prophylaxis in these patients, except for grades III to IV GVHD in HSCT. Thus, the timing for the initiation and cessation of IFI prophylaxis in immune-compromised patients remains a challenging endeavor. We retrospectively analyzed patients who received auto or allo-HSCT and monitored their immune function after recovering from neutropenia by measuring the levels of IgG, IgA, IgM, as well as the number of T, B, NK cells. We found that the level of IgG and NK cell count exhibited a significant difference with the incidence of IFI by logistic regression (p = 0.000 vs. 0.000, respectively) and conditional logistic regression (p = 0.009 vs. p = 0.002). The initiation of IFI prophylaxis was determined to be IgG < 7 mg/mL and NK cell count < 6.5 × 104/mL by an receiver operating characteristic curve separately. Tests in parallel increased the test sensitivity and specificity. Thus, the optimal timing for initiating prophylaxis in patients after HSCT could be IgG < 7 mg/mL or NK cell count < 6.5 × 104/mL. Future large-scale prospective clinical trials are required to verify these findings. Patients who are immuno-compromised after auto or allo-HSCT may benefit from a lower fungi infection incidence with immune surveillance and proper fungal prophylaxis.
Collapse
Affiliation(s)
- Jiexian Ma
- Department of Hematology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Hematology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingwei Hu
- Department of Hematology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Min Wu
- Department of Hematology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaoqin Wang
- Department of Hematology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yanhui Xie
- Department of Hematology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| |
Collapse
|
4
|
Park S, Kim K, Jang JH, Kim SJ, Kim WS, Chung DR, Kang CI, Peck KR, Jung CW. Randomized trial of micafungin versus fluconazole as prophylaxis against invasive fungal infections in hematopoietic stem cell transplant recipients. J Infect 2016; 73:496-505. [DOI: 10.1016/j.jinf.2016.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/01/2016] [Accepted: 06/20/2016] [Indexed: 01/17/2023]
|
5
|
Liu YC, Chien SH, Fan NW, Hu MH, Gau JP, Liu CJ, Yu YB, Liu CY, Hsiao LT, Liu JH, Chiou TJ, Chen PM, Tzeng CH. Incidence and risk factors of probable and proven invasive fungal infection in adult patients receiving allogeneic hematopoietic stem cell transplantation. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 49:567-74. [DOI: 10.1016/j.jmii.2015.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/19/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
|
6
|
Initial fluconazole prophylaxis may not be required in adults with acute leukemia or myelodysplastic/myeloproliferative disorders after reduced intensity conditioning peripheral blood stem cell allogeneic transplantation. Ann Hematol 2014; 94:663-9. [DOI: 10.1007/s00277-014-2259-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
|
7
|
Takaoka K, Nannya Y, Shinohara A, Arai S, Nakamura F, Kurokawa M. A novel scoring system to predict the incidence of invasive fungal disease in salvage chemotherapies for malignant lymphoma. Ann Hematol 2014; 93:1637-44. [PMID: 24908330 DOI: 10.1007/s00277-014-2093-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
The requirement of antifungal prophylaxis has not been established in the chemotherapies for malignant lymphoma. This study was conducted to explore the incidence of invasive fungal diseases (IFD) and their risk factors in patients receiving salvage therapies for malignant lymphoma. We retrospectively analyzed 177 consecutive patients who received these therapies (705 courses in total) at our institute. IFD were observed in 16 courses and the incidence was 2.3 %. A multivariate analysis showed that the factors associated with IFD were primary refractoriness (adjusted odds ratio (aOR), 4.22; 95 % confidence interval (CI), 1.38-13.0; p value = 0.012), two (aOR, 10.5, 95 % CI, 1.20-91.7; p = 0.033) or more (aOR, 26.2; 95 % CI, 3.27-210; p = 0.002) previous treatment lines, and the minimum neutrophil count during the therapies equal to or less than 500/μL (aOR, 9.69; 95 % CI, 1.25-74.9; p = 0.030). Using these factors, we created the IFD scoring model by assigning one point to each of primary refractoriness, two previous treatment lines and treatment that caused neutropenia (≤500/μL minimal neutrophil count) and two points to three or more previous treatment lines. The IFD incidence of lower risk group (IFD score <3) was 0.19 % and that of higher (IFD score ≥3) was 9.0 %. In conclusion, adequate prophylaxis for IFD might be required for patients with primary refractoriness, repeated therapies, or therapies which cause neutropenia. Furthermore, the IFD scoring model of this study underscores the need to account for disease and host factors in determining administration of adequate prophylaxis in salvage treatments for malignant lymphoma.
Collapse
Affiliation(s)
- Kensuke Takaoka
- Department of Hematology & Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo City, Tokyo, 1138655, Japan
| | | | | | | | | | | |
Collapse
|
8
|
Strasfeld L, Weinstock DM. Antifungal prophylaxis among allogeneic hematopoietic stem cell transplant recipients: current issues and new agents. Expert Rev Anti Infect Ther 2014; 4:457-68. [PMID: 16771622 DOI: 10.1586/14787210.4.3.457] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Invasive candidiasis and invasive mold infections cause significant morbidity and mortality in the hematopoietic stem cell transplant population, in particular in recipients of allografts. The introduction of a variety of new antifungal compounds over the past decade has focused attention on prophylactic strategies as a means to decrease the burden of invasive fungal infections (IFIs). Until recently, fluconazole has been the standard agent for prophylaxis before and after engraftment. In 2005, the echinocandin micafungin received US FDA approval for prophylaxis against IFIs in stem cell transplant recipients during the neutropenic period prior to engraftment. In patients with substantial risk for invasive mold infection, many centers now use a mold-active antifungal agent (e.g., a triazole such as itraconazole, voriconazole or posaconazole, or an echinocandin) as prophylaxis after engraftment. Several recent studies have highlighted the efficacy of these newer agents in preventing IFIs in these highly immunocompromised patients. This review will discuss current issues in IFI and new agents available for prophylaxis in allogeneic hematopoietic stem cell transplant recipients.
Collapse
Affiliation(s)
- Lynne Strasfeld
- Weill Medical College of Cornell University, Department of Medicine, Division of International Medicine and Infectious Diseases, 1300 York Avenue, A-421, New York, NY 10021, USA.
| | | |
Collapse
|
9
|
Omer AK, Ziakas PD, Anagnostou T, Coughlin E, Kourkoumpetis T, McAfee SL, Dey BR, Attar E, Chen YB, Spitzer TR, Mylonakis E, Ballen KK. Risk factors for invasive fungal disease after allogeneic hematopoietic stem cell transplantation: a single center experience. Biol Blood Marrow Transplant 2013; 19:1190-6. [PMID: 23747459 DOI: 10.1016/j.bbmt.2013.05.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/29/2013] [Indexed: 11/30/2022]
Abstract
Invasive fungal disease (IFD) is a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HCT). We performed a retrospective review of 271 adults with a hematologic malignancy undergoing allogeneic HCT to determine the incidence of and risk factors for IFD and to examine the impact of IFD on nonrelapse mortality and overall survival. We defined IFD using standard criteria and selected proven and probable cases for analysis. Diagnoses in the study group included acute leukemia (42%), non-Hodgkin lymphoma (24%), myelodysplastic syndrome (15%), chronic lymphocytic leukemia (5%), and other hematologic disorders (14%). Conditioning included reduced-intensity (64%) and myeloablative (36%) regimens. Donor sources were HLA-matched sibling (60%), matched unrelated (20%), haploidentical (12%), and cord blood (8%). A total of 51 episodes of IFD were observed in 42 subjects (15%). Aspergillus spp (47%) was the most frequent causative organism, followed by Candida spp (43%). The majority of IFD cases (67%) were reported after day +100 post-HCT. In multivariate analysis, haploidentical donor transplantation (hazard ratio [HR], 3.82; 95% confidence interval [CI], 1.49-9.77; P = .005) and grade II-IV acute graft-versus-host disease (HR, 2.55; 95% CI, 1.07-6.10; P = .03) were risk factors for the development of IFD. Conversely, higher infused CD34(+) cell dose was associated with a lower risk of IFD (HR, 0.80; 95% CI, 0.68-0.94; P = .006, per 1 × 10(6) cells/kg increase in CD34(+) cell infusion). IFD-related mortality was 33.3%. Nonrelapse mortality was significantly higher in patients who developed IFD compared with those without IFD (P < .001, log-rank test). Patients with IFD had lower overall survival (5.8 months versus 76.1 months; P < .001, log-rank test). Further studies exploring strategies to increase the infused cell dose and determine adequate prophylaxis, especially against aspergillus, beyond day +100 are needed.
Collapse
Affiliation(s)
- Aazim K Omer
- Department of Medicine, North Shore Medical Center, Salem, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Cámara RDL, Mensa J, Carreras E, Cuenca Estrella M, García Rodríguez JÁ, Gobernado M, Picazo J, Aguado JM, Sanz MÁ. Profilaxis antifúngica en pacientes oncohematológicos: revisión de la bibliografía médica y recomendaciones. Med Clin (Barc) 2010; 134:222-33. [DOI: 10.1016/j.medcli.2009.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 10/20/2009] [Indexed: 01/05/2023]
|
11
|
Risk factors for invasive fungal infections in haematopoietic stem cell transplantation. Int J Antimicrob Agents 2008; 32 Suppl 2:S119-23. [DOI: 10.1016/s0924-8579(08)70012-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
12
|
Jantunen E, Nihtinen A, Anttila VJ. Changing landscape of invasive aspergillosis in allogeneic stem cell transplant recipients. Transpl Infect Dis 2008; 10:156-61. [DOI: 10.1111/j.1399-3062.2008.00301.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Nihtinen A, Anttila VJ, Elonen E, Juvonen E, Volin L, Ruutu T. Effect of fluconazole prophylaxis on the incidence of invasive candida infections and bacteraemias in patients with acute leukaemia. Eur J Haematol 2008; 80:391-6. [DOI: 10.1111/j.1600-0609.2008.01041.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Agirbasli H, Otlu B, Bilgen H, Durmaz R, Gedikoglu G. Epidemiological characteristics of fatal Candida krusei fungemia in immunocompromised febrile neutropenic children. Infection 2007; 36:88-91. [PMID: 18084719 DOI: 10.1007/s15010-007-6246-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
|
15
|
Nihtinen A, Anttila VJ, Richardson M, Meri T, Volin L, Ruutu T. The utility of intensified environmental surveillance for pathogenic moulds in a stem cell transplantation ward during construction work to monitor the efficacy of HEPA filtration. Bone Marrow Transplant 2007; 40:457-60. [PMID: 17589532 DOI: 10.1038/sj.bmt.1705749] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 12-week environmental study was performed to ensure that the patient rooms of an SCT ward with high-efficiency particulate air (HEPA) filtration remained uncontaminated by moulds during close-by construction work. The sampling included measuring the ventilation channel pressure, particle count measurements, air sampling, settled dust analysis and fungal cultures from the oral and nasal cavities of the patients. No changes in the air pressure occurred. Median particle counts in patient rooms were 63-420 particles/l. The mean particle count of the outside air was 173,659 particles/l. Patient room air samples were negative for aspergilli in 32 of 33 cases. All samples of the outside air were positive for moulds. Aspergillus fumigatus was isolated at the beginning of excavation works at the construction area and in two of 33 dust samples from patient rooms. All 70 nasal samples were negative. Of 35 mouth samples, one sample was positive for A. niger in a patient with a previously diagnosed aspergillus infection. During a median follow-up of 214 days, no invasive aspergillus infections were diagnosed in the 55 patients treated during the construction period. In conclusion, the HEPA filters seemed to have performed well in preventing an aspergillosis outbreak.
Collapse
Affiliation(s)
- A Nihtinen
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
16
|
Post MJ, Lass-Floerl C, Gastl G, Nachbaur D. Invasive fungal infections in allogeneic and autologous stem cell transplant recipients: a single-center study of 166 transplanted patients. Transpl Infect Dis 2007; 9:189-95. [PMID: 17511828 DOI: 10.1111/j.1399-3062.2007.00219.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Invasive fungal infections (IFIs) remain a major cause of infection-related morbidity and mortality following hematopoietic stem cell transplantation (HSCT). PATIENTS AND METHODS We retrospectively analyzed the incidence of IFIs in 166 patients undergoing either allogeneic or autologous HSCT at our institution between January 2000 and December 2003. RESULTS Incidence of invasive aspergillosis (IA) and invasive candidiasis among allogeneic HSCT recipients was 23% (16-32%, 95% confidence interval [CI]) and 3% (1-9%, 95% CI), respectively. Duration of neutropenia and reduced-intensity conditioning were the only risk factors for IA in the multivariate model. Patients with IA had significantly reduced overall survival (8% versus 56%, P=0.01) due to higher transplant-related mortality (63% versus 31%, P=0.03). Following autologous HSCT, incidence of IA and invasive candidiasis was 8% (4-19%, 95% CI) and 2% (0.2-11%, 95% CI), respectively. Duration of neutropenia was the only risk factor for the development of IA following autologous HSCT. Overall survival of autologous HSCT recipients with IA was similar to that of patients without IA. Seventeen percent of autologous HSCT recipients were colonized with Candida species. Compared with non-colonized patients these patients had significantly reduced overall survival (72% versus 23%, P=0.004), due to increased treatment-related mortality (23% versus 9%, P=0.02). CONCLUSION Diagnosis of IA following allogeneic HSCT and Candida colonization in the setting of autologous HSCT defines patient populations with poor outcome but primarily not as a result of the fungal pathogen. Regarding the incidence of IA, duration of neutropenia is the main risk factor, and dose-reduced conditioning is an additional risk factor for the development of IA following allogeneic HSCT, probably owing to increased recipient age in this patient cohort, requiring further studies in this transplantation setting.
Collapse
Affiliation(s)
- M J Post
- Clinical Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | | | | | | |
Collapse
|
17
|
|
18
|
Abstract
OBJECTIVE To review the available clinical data on the critical care complications of hematopoietic stem cell transplantation (HSCT). DATA SOURCE The MEDLINE database and references from the identified articles related to the critical care in HSCT. CONCLUSION HSCT is an important treatment for a variety of malignant and nonmalignant conditions. The procedure is, however, limited by significant complications that may involve every organ of the body. Up to 40% of HSCT recipients are admitted to the intensive care unit as a result of severe complications related to the transplantation. The outcome of those critically ill patients has been traditionally poor. However, recent advances in the transplantation procedure, diagnostic studies, antimicrobial prophylaxis and therapy, and intensive care unit care have improved the outcome of these patients. The increasing number of HSCTs performed annually, the unique complications that develop in these patients, and the improvement in the intensive care unit outcome make knowledge about the critical care aspect of HSCT an essential part of the current practice of critical care medicine.
Collapse
Affiliation(s)
- Ayman O Soubani
- Division of Pulmonary, Critical Care, and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|