Reducing infectious complications after allogeneic stem cell transplant

ABSTRACT

Introduction

Infections remain a significant problem, in patients undergoing an allogeneic hematopoietic stem-cell transplant (HSCT) and efforts have been made over the years, to reduce the incidence, morbidity and mortality of infectious complications.

Areas covered

This manuscript is focused on the epidemiology, risk factors and prevention of infections after allogeneic HSCT. A systematic literature review was performed using the PubMed database, between November 2019 and January 2020, with the following MeSH terms: stem-cell transplantation, infection, fungal, bacterial, viral, prophylaxis, vaccines, prevention. The authors reviewed all the publications, and following a common revision, a summary report was made and results were divided in three sections: bacterial, fungal and viral infections.

Expert opinion

Different infections occur in the early, intermediate and late post-transplant period, due to distinct risk factors. Improved diagnostic techniques, pre-emtive therapy and better prophylaxis of immunologic complications, have reduced the morbidity and mortality of infections. The role of the gut microbiota is under careful scrutiny and may further help us to identify high-risk patients.

KEYWORDS:

• HSCT
• bacteria
• virus
• fungal
• prophylaxis

Article highlights

• Centres offering allogenic HSCT should document the incidence and epidemiology of infections in order to adjust therapy accordingly.

• The risk for invasive fungal infections in allogenic HSCT is dynamic. Re-evaluation of new appearing risk factors during the transplantation process is mandatory, to adapt prophylaxis when needed.

• I HSCT centres should train patients and relatives for preventing infections in the hospital, at home and in the community.

• Baseline serostatus for recipient and donor should be carefully assessed and managed before starting the conditioning regimen.

• Prevention of acute and chronic GvHD, leading to a rapid immune recovery, remains the key issue for a safe post-transplant outcome.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.