scholarly journals Delayed opportunistic infections in hematopoietic stem cell transplantation patients: a surmountable challenge

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 265-270 ◽  
Author(s):  
Kieren A. Marr
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Bacterial Infections ◽  
Opportunistic Infections ◽  
Invasive Infection ◽  
Prevention Strategies ◽  
Hematopoietic Stem

Abstract Changes in the transplantation procedure and the implementation of effective supportive care strategies have decreased the incidence of infectious complications early after conditioning therapy for allogeneic hematopoietic stem cell transplantation (HCT) and have extended the duration of risks later. Therefore, the types of infections that cause significant morbidity and the timing of risks have changed. These late infections are caused by all types of organisms, bacterial, viral, and fungal, but risks are predictable and surmountable with the use of tailored prevention strategies. Specifically, recent studies document prolonged risks for bacterial infections in the setting of GVHD, especially those caused by encapsulated organisms and those secondary to impaired Ab responses. Both prophylaxis and vaccination strategies can be used as a means to prevent infections, which typically manifest in the respiratory tract. Multiple viruses cause infection later after HCT, including several herpesviruses (eg, CMV and varicella zoster virus) and other respiratory viruses such as influenza and adenovirus. These infections can cause severe disease with diagnostic challenges, but prevention strategies using enhanced monitoring and/or prophylaxis may be effective. Finally, fungi also cause disease late after HCT, especially filamentous fungi (eg, Aspergillus species and Mucormycoses) and Pneumocystis jiroveci; prophylactic strategies may be used successfully to prevent invasive infection. Late infections and methods to prevent them are reviewed herein.

The impact of cytomegalovirus serostatus of donor and recipient before hematopoietic stem cell transplantation in the era of antiviral prophylaxis and preemptive therapy

Blood ◽  
2004 ◽  
Vol 103 (6) ◽  
pp. 2003-2008 ◽  
Author(s):  
Michael Boeckh ◽  
W. Garrett Nichols
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cohort Studies ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Preemptive Therapy ◽  
Prevention Strategies ◽  
Hematopoietic Stem ◽  
The Impact

AbstractIn the current era of effective prophylactic and preemptive therapy, cytomegalovirus (CMV) is now a rare cause of early mortality after hematopoietic stem cell transplantation (HSCT). However, the ultimate goal of completely eliminating the impact of CMV on survival remains elusive. Although the direct effects of CMV (ie, CMV pneumonia) have been largely eliminated, several recent cohort studies show that CMV-seropositive transplant recipients and seronegative recipients of a positive graft appear to have a persistent mortality disadvantage when compared with seronegative recipients with a seronegative donor. Recipients of T-cell–depleted allografts and/or transplants from unrelated or HLA-mismatched donors seem to be predominantly affected. Reasons likely include both incomplete prevention of direct and indirect or immunomodulatory effects of CMV as well as consequences of drug toxicities. The effect of donor CMV serostatus on outcome remains controversial. Large multicenter cohort studies are needed to better define the subgroups of seropositive patients that may benefit from intensified prevention strategies and to define the impact of CMV donor serostatus in the era of high-resolution HLA matching. Prevention strategies may require targeting both the direct and indirect effects of CMV infection by immunologic or antiviral drug strategies.

CCR7 impairs hematopoiesis after hematopoietic stem cell transplantation increasing susceptibility to invasive aspergillosis

Blood ◽  
2010 ◽  
Vol 116 (24) ◽  
pp. 5383-5393 ◽  
Author(s):  
Adam J. Hartigan ◽  
Lara E. Kallal ◽  
Cory M. Hogaboam
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Invasive Aspergillosis ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Murine Model ◽  
Cell Expansion ◽  
Opportunistic Infections ◽  
Hematopoietic Stem

Abstract Hematopoietic stem cell transplantation (HSCT) is limited by patient susceptibility to opportunistic infections. One of the most devastating infections after HSCT is invasive aspergillosis (IA), a life-threatening disease caused by Aspergillus fumigatus. Transplantation of hematopoietic stem cells (HSCs) and myeloid progenitor cells (MPCs) has been shown to mediate protection against IA, but little is known about the factors that regulate HSC and MPC cell expansion after transplantation. Herein, we investigated the role of CCR7 in a murine model of IA after combined HSC and MPC transplantation into lethally irradiated wild-type (WT) mice. Nonirradiated CCR7−/− mice had expanded populations of HSCs in the bone marrow and spleen, compared with WT mice. Irradiated WT mice reconstituted with CCR7−/− HSCs and MPCs had increased survival, decreased fungal burden, and enhanced myeloid leukocyte numbers during IA, compared with WT controls. In addition, WT mice reconstituted with WT HSCs and MPCs and treated with anti-CCR7 exhibited accelerated myeloid cell expansion similar to that observed in CCR7−/−→WT chimeras. Thus, removal of the inhibitory effects of CCR7 through genetic alteration or ligand immunoneutralization enhanced myeloid reconstitution, thereby accelerating fungal clearance in a murine model of IA.

scholarly journals The association of conditioning regimen with cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation

2020 ◽  
Author(s):  
Masoud Mardani ◽  
Sara Abolghasemi ◽  
Shiva Shabani ◽  
Farzaneh Tavakoli ◽  
Anahita Saeedi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Viral Infections ◽  
Opportunistic Infections ◽  
Conditioning Regimen ◽  
Hematopoietic Stem ◽  
Cmv Reactivation

Background and Objectives: Infections is yet one of the life-threatening complications of the hematopoietic stem cell transplantation (HSCT). The myeloablative and immunosuppressive conditioning regimens, which are administered before HSCT, dampen the defense capacity of the recipients’ immune systems. In this condition, opportunistic infections, especially viral infections such as cytomegalovirus (CMV) can be reactivated and cause morbidity and mortality in HSCT patients. Here, we aimed to find out any possible relationship between types of conditioning regimen and CMV reactivation in allo- geneic HSCT patients. Materials and Methods: We retrospectively analyzed the data of 145 CMV-seropositive cases out of total 201 allo-HSCT patients, including age, gender, underlying disease, conditioning regimen, prophylaxis regimen and occurrence of acute graft-versus-host disease (aGVHD) to evaluate their roles in CMV reactivation. Results: Our result showed that conditioning regimen containing Busulfan and Fludarabine (P=0.003) or Cyclophospha- mide (P=0.02) significantly decrease the early CMV reactivation. Patients who developed aGVHD (P=0.003) and those who received anti-thymocyte globulin (ATG) as prophylaxis regimen (P=0.002), had 1.84 and 2.63 times higher risks of CMV reactivation, respectively. Conclusion: Our findings suggest the conditioning regimen, aGVHD and ATG as influencing factors for early CMV reacti- vation post-HSCT which should be considered in the future studies.

scholarly journals ANTIBACTERIAL RESISTANCE IN PATIENTS WITH HEMATOPOIETIC STEM CELL TRANSPLANTATION

2016 ◽  
Vol 9 (1) ◽  
pp. e2017002 ◽  
Author(s):  
Murat Akova
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Bacterial Infections ◽  
Infectious Complications ◽  
Morbidity And Mortality ◽  
Antibacterial Resistance ◽  
Hematopoietic Stem

Recipients of hematopoietic stem cell transplantation (HSCT) are at substantial risk of bacterial, fungal, viral, and parasitic infections depending on the time elapsed since transplantation, presence of graft-versus-host disease (GVHD), and the degree of immunosuppression. Infectious complications in HSCT recipients are associated with high morbidity and mortality. Bacterial infections constitute the major cause of infectious complications, especially in the early post-transplant period. The emergence of antibacterial resistance complicates the management of bacterial infections in this patient group. Multidrug-resistant bacterial infections in this group of patients have attracted considerable interest and may lead significant morbidity and mortality. Empirical antibacterial therapy in patients with HSCT and febrile neutropenia has a critical role in survival and should be based on local epidemiology. This review attempts to provide an overview of resistant bacterial infections in HSCT recipients. Keywords: Hematopoietic stem cell transplantation, antibacterial resistance, resistant bacterial infection.

scholarly journals Evaluation of the Bacterial Etiologies of Infections in Patients Undergoing Hematopoietic Stem Cell Transplantation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5850-5850
Author(s):  
Lokman Hizmali ◽  
Umit Tapan ◽  
Haluk Eraksoy
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Bacterial Infection ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Bacterial Infections ◽  
Bacterial Isolates ◽  
Gram Positive ◽  
Hematopoietic Stem

Abstract Objectives: Bacterial infections increase morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). The characteristics of the bacteria causing infections in these patients undergo dynamic changes both globally and locally during the transplantation process. The etiology of bacterial isolates and analysis of changes in the antibiotic sensitivities are crucial for the selection of appropriate prophylactic and empiric therapies. In this study we aimed to evaluate the first episode of bacterial infection in patients undergoing allogeneic or autologous hematopoietic stem cell transplantation and to identify bacterial isolates and the resistance profile of causative bacteria. Materials and Methods: In this retrospective study, the charts of 195 patients who underwent allogeneic or autologous hematopoietic stem cell transplantation between January 2010 and December 2013 were reviewed. Ninety-six patients who had microbiologic evidence of bacterial infection were included in the study. The culture results from the first infectious episode during the transplantation process were evaluated. Patients were grouped according to the type of transplantation, and categorized according to the transplantation process, presence of neutropenia and infection status. Microbiological examination of samples obtained for culture and sensitivity analysis were performed according to standards of the National Committee for Clinical Laboratory Standards Institute (CLSI). Results: Gram-negative and Gram-positive bacteria were identified in 54.2% and 44.8% of the infectious episodes, respectively. Poly-microbial etiology was identified in only 1.0% of these episodes. E. coli and coagulase-negative staphylococci (CoNS) were the most frequently isolated pathogens. In the early stage infections, Gram-positive organisms were more frequently isolated (72.1%) (p=0.042) and a significantly larger number of patients had undergone autologous stem cell transplantation (p<0.001). This situation was explained by the absence of antimicrobial prophylaxis in the autologous group, intensive induction chemotherapy, presence of catheter and mucosal damage. The frequency of extended-spectrum β-lactamase (ESBL) was found to be very high in the allogeneic group compared to the autologous group (36.4% vs. 13.3%). All of the staphylococcal isolates in the allogeneic group were noted to be methicillin resistant. Conclusions: Treatment and prophylaxis have become increasingly more challenging with the infections caused by resistant pathogens. It is imperative to carefully monitor causative agents of bacterial infections and to plan prophylactic and empiric treatments according to characteristics of the individual patients. Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document