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Volume 12, Number 3, 2007

Strategies for prevention of infectious complications in children after HSCT in relation to type of transplantation and GVHD occurrence

Jan Styczyński, Lidia Gil


<b>Background</b> Infectious complications are a major cause of morbidity and mortality in paediatric and adult patients undergoing haematopoietic stem cell transplantation (HSCT).
<b>Aim</b> Analysis of strategies for prevention of infectious complications in children after
HSCT in relation to the type of transplantation and GVHD occurrence.
<b>Materials/Methods</b> A review of PubMed references based on evidence-based recommendations rated by the strength of the recommendation and the quality of the supporting evidence. The risk of infection was divided into: low for autologous HSCT, moderate for MSD-HSCT without GVHD, and high for unrelated, mismatched, haploidentical
HSCT, cord blood HSCT, patients with moderate-to-severe GVHD, undergoing
immunosuppressive treatment, CMV infection, ex vivo T-cell depletion or
CD34 selection and in vivo T-cell depletion.
<b>Results</b> Prophylaxis strategy includes general infection control in hospital environment and pharmacological approach, related to antibacterial, antifungal and antiviral
agents. Most studies were done on adult patients only, while some included both
paediatric and adults patients. However, no differences in prophylaxis strategy and
efficacy between age groups were reported in these studies. Recommendations
for use of specifi c drugs in prophylaxis in transplantation period and recommendations
for vaccination are presented in this paper.
<b>Conclusions</b> With changing practices, transplant teams are encouraged to review local patterns of infections and associated complications and communicate regularly with infection control committees for guidance on the evolution of isolation needs for the immunosuppressed patient before and after HSCT.

Signature: Rep Pract Oncol Radiother, 2007; 12(3) : 149-157


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