Bacterial Pneumonia in Recipients of Bone Marrow Transplantation

Lossos, Izidore S.; Breuer, Raphael; Or, Reuven; Strauss, Nurith; Elishoov, H.; Naparstek, Elizabeth; Aker, Memet; Nagler, Arnon; Moses, Allon E.; Shapiro, Mervyn; Slavin, Shimon; Engelhard, Dan

doi:10.1097/00007890-199510150-00010

Cited by 89 publications

(65 citation statements)

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“…The lung is a common target of infection after BMT, and bacterial pneumonias with Gram-negative rods and Gram-positive cocci predominate (1,3,4). The reported incidence of infectious pneumonia in BMT recipients varies from 11-30% (2,5,6). Associated mortality has been estimated at ϳ22% in one study, with nosocomial pathogens leading to a significantly worse outcome (5).…”

Section: Defective Phagocytosis and Clearance Of Pseudomonas Aeruginomentioning

confidence: 99%

“…The reported incidence of infectious pneumonia in BMT recipients varies from 11-30% (2,5,6). Associated mortality has been estimated at ϳ22% in one study, with nosocomial pathogens leading to a significantly worse outcome (5).…”

Section: Defective Phagocytosis and Clearance Of Pseudomonas Aeruginomentioning

confidence: 99%

“…It is especially virulent in the immunocompromised patient with structural or functional immune defects (4,5,7,8). Immunodeficiency in the immediate post-transplant period is usually ascribed to the accompanying neutropenia.…”

Section: Defective Phagocytosis and Clearance Of Pseudomonas Aeruginomentioning

confidence: 99%

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Defective Phagocytosis and Clearance of Pseudomonas aeruginosa in the Lung Following Bone Marrow Transplantation

Ojielo

Cooke²,

Mancuso

et al. 2003

The Journal of Immunology

128

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Bone marrow transplantation (BMT) is an important therapeutic option for a variety of malignant and nonmalignant disorders. Unfortunately, BMT recipients are at increased risk of infection, and in particular, pulmonary complications occur frequently. Although the risk of infection is greatest during the neutropenic period immediately following transplant, patients are still vulnerable to pulmonary infections even after neutrophil engraftment. We evaluated the risk of infection in this postengraftment period by using a well-established mouse BMT model. Seven days after syngeneic BMT, B6D2F1 mice are no longer neutropenic, and by 3 wk, they demonstrate complete reconstitution of the peripheral blood. However, these mice remain more susceptible throughout 8 wk to infection after intratracheal administration of Pseudomonas aeruginosa; increased mortality in the P. aeruginosa-infected BMT mice correlates with increased bacterial burden in the lungs as well as increased systemic dissemination. This heightened susceptibility to infection was not secondary to a defect in inflammatory cell recruitment to the lung. The inability to clear P. aeruginosa in the lung correlated with reduced phagocytosis of the bacteria by alveolar macrophages (AMs), but not neutrophils, decreased production of TNF-α by AMs, and decreased levels of TNF-α and IFN-γ in the bronchoalveolar lavage fluid following infection. Expression of the β2 integrins CD11a and CD11c was reduced on AMs from BMT mice compared with wild-type mice. Thus, despite restoration of peripheral blood count, phagocytic defects in the AMs of BMT mice persist and may contribute to the increased risk of infection seen in the postengraftment period.

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Section: Defective Phagocytosis and Clearance Of Pseudomonas Aeruginomentioning

confidence: 99%

Section: Defective Phagocytosis and Clearance Of Pseudomonas Aeruginomentioning

confidence: 99%

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Defective Phagocytosis and Clearance of Pseudomonas aeruginosa in the Lung Following Bone Marrow Transplantation

Ojielo

Cooke²,

Mancuso

et al. 2003

The Journal of Immunology

128

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“…[4][5][6] The impairment of the immune system in the first period after auto-SCT is reflected in the high incidence of infectious complications, which is a major source of morbidity. 7,8 B lymphocyte numbers in peripheral blood normalize within 6-12 months after auto-SCT, but the capacity to mount an adequate antibody response to vaccination is low until 6 months after transplantation and gradually improves thereafter. 9,10 Several studies on the quantitative development of cellular immunity after auto-SCT found normal or even high levels of natural killer cells 2 weeks after transplantation.…”

Section: Introductionmentioning

confidence: 99%

Development of T cell-mediated immunity after autologous stem cell transplantation: prolonged impairment of antigen-stimulated production of γ-interferon

Velden

Claessen

Velzen‐Blad

et al. 2007

Bone Marrow Transplant

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The conditioning regimens for autologous SCT (auto-SCT) lead to impairment of the immune system and concomitant increase in susceptibility to infections. We studied the recovery of cellular immunity by in vitro analysis of T-cell proliferation and cytokine production profiles during the first 15 months after auto-SCT in patients with multiple myeloma and non-Hodgkin's lymphoma. PBMC were collected at 6, 9 and 15 months after transplantation and stimulated with a combination of CD2 and CD28 monoclonal antibodies, with PHA or with tetanus toxoid as recall antigen. A multiplex enzyme linked immunoassay was used to determine levels of QJ;Th1 cytokines IL-2, IFN-c and tumour-necrosis factor-a (TNFa), Th2 cytokines IL-4, IL-5 and IL-13, the regulatory cytokine IL-10 and the proinflammatory cytokines IL-1a, IL-1b, IL-6 and the chemokine IL-8. T-cell proliferation progressively increased from 6 to 15 months after auto-SCT. Overall, cytokine production increased after auto-SCT. Production of Th2 cytokines IL-5 and IL-13 was superior to production of Th1 cytokines IFN-c and TNF-a. We hypothesize that prolonged impairment of IFN-c production might contribute to the relatively high incidence of viral infections after auto-SCT.

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“…[9][10][11] Because of these reasons, it is essential to reimmunize peripheral blood stem cell (PBSCT) or bone marrow transplant (BMT) recipients at appropriate times following transplantation. [12][13][14] …”

mentioning

confidence: 99%

Reimmunization after blood or marrow stem cell transplantation

Singhal

Mehta

1999

Bone Marrow Transplant

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Summary:Protective immunity to diseases preventable by routine vaccination is lost over time following allogeneic and autologous blood and marrow transplantation. Adoptive transfer of immunity from donors to recipients after allogeneic transplantation is not sufficient to prevent this decline. Systematic reimmunization is necessary at appropriate time intervals following transplantation to re-establish immunity. Response to vaccination depends upon the type of transplant, the source of cells, the immune status of the patient, and the vaccine being used. While inactivated or subunit vaccines are safe in all transplant recipients, live vaccines are generally contraindicated. Reimmunization practices vary widely amongst transplant centers. This comprehensive review summarizes published data on post-transplant vaccination, and based upon these, suggests guidelines which may be used as a framework for development of reimmunization protocols. Keywords: allogeneic bone marrow transplantation; autologous bone marrow transplantation; hematopoietic stem cell transplantation; immunization; vaccination Passive immunization consists of the administration of antibody-containing immunoglobulin preparations to provide temporary protection. Active immunization refers to the administration of a vaccine or a toxoid and is analogous to vaccination. 1 Vaccines available for routine use in children include diphtheria-pertussis-tetanus (DPT), trivalent polio, measles-mumps-rubella (MMR), Haemophilus influenzae type b (Hib), hepatitis B and tuberculosis (BCG). Adult vaccines include diphtheria-tetanus (DT), hepatitis B, influenza virus and pneumococcus. The use of meningococcal, hepatitis A and varicella vaccines is increasing. A number of other vaccines are also available for special circumstances. 1 Most allogeneic and a large proportion of autologous bone marrow transplant recipients lose their immunity to poliovirus, tetanus, diphtheria and measles after transplantation. 2 risk of developing infections with organisms such as H. influenzae and Streptococcus pneumoniae for which vaccines are available. 9-11 Because of these reasons, it is essential to reimmunize peripheral blood stem cell (PBSCT) or bone marrow transplant (BMT) recipients at appropriate times following transplantation. 12-14 Current practiceSystematic post-transplant reimmunization is a relatively neglected area. 12,14 A survey of reimmunization protocols in Europe found wide variations in practice. 12 Tetanus toxoid vaccination was the most common practice, with 65% of the surveyed centers administering this to allograft recipients, and 37% to autograft recipients. On the other hand, pertussis vaccination was the least common practice, with only one center using this. 12 A survey of 45 North American transplant centers affiliated with the National Marrow Donor Program 14 showed that 97% of centers allografting patients under the age of 7 years and 88% of those allografting patients aged 7 years or older gave either the DPT or the DT vaccine, whereas 77% and 58%, res...

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Bacterial Pneumonia in Recipients of Bone Marrow Transplantation

Cited by 89 publications

References 0 publications

Defective Phagocytosis and Clearance of Pseudomonas aeruginosa in the Lung Following Bone Marrow Transplantation

Defective Phagocytosis and Clearance of Pseudomonas aeruginosa in the Lung Following Bone Marrow Transplantation

Development of T cell-mediated immunity after autologous stem cell transplantation: prolonged impairment of antigen-stimulated production of γ-interferon

Reimmunization after blood or marrow stem cell transplantation

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