A Review of Infections After Hematopoietic Cell Transplantation Requiring PICU Care: Transplant Timeline Is Key

Abstract

Despite major advances in antimicrobial prophylaxis and therapy, opportunistic infections remain a major cause of morbidity and mortality after pediatric hematopoietic cell transplant (HCT). Risk factors associated with the development of opportunistic infections include the patient's underlying disease, previous infection history, co-morbidities, source of the donor graft, preparative therapy prior to the graft infusion, immunosuppressive agents, early and late toxicities after transplant, and graft-vs.-host disease (GVHD). Additionally, the risk for and type of infection changes throughout the HCT course and is greatly influenced by the degree and duration of immunosuppression of the HCT recipient. Hematopoietic cell transplant recipients are at high risk for rapid clinical decompensation from infections. The pediatric intensivist must remain abreast of the status of the timeline from HCT to understand the risk for different infections. This review will serve to highlight the infection risks over the year-long course of the HCT process and to provide key clinical considerations for the pediatric intensivist by presenting a series of hypothetical HCT cases.

Fluoroquinolone prophylaxis in patients with neutropenia at high risk of serious infections: Exploring pros and cons

“…Patients with AML or relapsed ALL appear to be at high risk during all periods of neutropenia, whereas those with ALL receiving up‐front therapy appear to be at the highest risk only during induction therapy, and the risk is further increased if more chemotherapy agents are given in combination during the remission‐induction phase 103,104 . Similarly, for patients receiving HSCT, higher risk of serious bacterial infection is associated with allogeneic transplant, and with stem cell sources associated with higher risk of prolonged neutropenia (such as umbilical cord) or graft‐versus‐host disease 105,106 . Other host factors such as comorbidities, functional status, previous chemotherapy tolerance, and infectious complications and MDRO colonization status may also be considered.…”

Worked to the bone: antibody-based conditioning as the future of transplant biology

“…Myeloablative regimens prolong neutropenia and lymphopenia, while reduced intensity regimens require a higher dose of immunosuppressive drugs. Thus, both heighten the risk of infection [ 126 ]. Also, the choice of GvHD prophylaxis plays a major role in post-transplant immunosuppression.…”

Análise dos fatores associados ao retransplante de células-tronco hematopoiéticas: estudo caso-controle

“…The infections can easily progress to sepsis in immunosuppressed HSCT candidates 29 . As shown in the results of this study, patients with sepsis are more likely to have retransplantation (OR = 6.03; CI = 95%: 1.386-26.205; p = 0.017).…”