Immune reconstitution after hematopoietic stem-cell transplantation and its influence on respiratory infections1

Matulis, M; High, Kevin P.

doi:10.1053/srin.2002.33441

Cited by 17 publications

(9 citation statements)

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“…In one respect, the HSC transplantation recipient may present a less confusing clinical diagnostic picture than that of other immunocompromised patients because specific complications tend to occur within well defined time periods ( Figure 5) (220). The timing and intensity of cytoreductive therapies, the pattern of immune reconstitution that follows, and the use of prophylactic strategies for infectious agents influence the duration of these intervals (222).…”

Section: General Risk Factors For Pulmonary Complicationsmentioning

confidence: 99%

Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation

Kotloff

Ahya

Crawford

2004

Am J Respir Crit Care Med

340

253

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The ability to successfully transplant solid organs and hematopoietic stem cells represents one of the landmark medical achievements of the twentieth century. Solid organ transplantation has emerged as the standard of care for select patients with severe vital organ dysfunction and hematopoietic stem cell transplantation has become an important treatment option for patients with a wide spectrum of nonmalignant and malignant hematologic disorders, genetic disorders, and solid tumors. Although advances in surgical techniques, immunosuppressive management, and prophylaxis and treatment of infectious diseases have made long-term survival an achievable goal, transplant recipients remain at high risk for developing a myriad of serious and often life-threatening complications. Paramount among these are pulmonary complications, which arise as a consequence of the immunosuppressed status of the recipient as well as from such factors as the initial surgical insult of organ transplantation, the chemotherapy and radiation conditioning regimens that precede hematopoietic stem cell transplantation, and alloimmune mechanisms mediating host-versus-graft and graft-versus-host responses. As the population of transplant recipients continues to grow and as their care progressively shifts from the university hospital to the community setting, knowledge of the pulmonary complications of transplantation is increasingly germane to the contemporary practice of pulmonary medicine.

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Section: General Risk Factors For Pulmonary Complicationsmentioning

confidence: 99%

Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation

Kotloff

Ahya

Crawford

2004

Am J Respir Crit Care Med

340

253

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“…Moreover, mortality rates for HSCT recipients with pulmonary infiltrates requiring mechanical ventilation approach 90% (2). Conditioning regimen, reconstitution of the immune system, and prophylactic strategy for infection influence the incidence of pulmonary complications following HSCT (3). Infectious complications are more common in allogeneic HSCT recipients because of graft-versus-host disease (GVHD) itself and the prophylactic or therapeutic immunosuppressive therapy for GVHD (4,5).…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Complications After Hematopoietic Stem Cell Transplantation

Lim

Lee

et al. 2006

J Korean Med Sci

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Despite advanced effective prophylaxes, pulmonary complications still occur in a high proportion of all hematopoietic stem cell recipients, accounting for considerable morbidity and mortality. The aim of our study was to describe the causes, incidences and mortality rates secondary to pulmonary complications and risk factors of such complications following hematopoietic stem cell transplantation (HSCT). We reviewed the medical records of 287 patients who underwent either autologous or allogeneic HSCT for hematologic disorders from February 1996 to October 2003 at Samsung Medical Center (134 autografts, 153 allografts). The timing of pulmonary complications was divided into pre-engraftment, early and late period. The spectrum of pulmonary complications included infectious and non-infectious conditions. 73 of the 287 patients (25.4%) developed pulmonary complications. Among these patients, 40 (54.8%) and 29 (39.7%) had infectious and non-infectious conditions, respectively. The overall mortality rate from pulmonary complications was 28.8%. Allogeneic transplant, grade II-IV acute graft-versus-host disease (GVHD) and extensive chronic GVHD were the risk factors with statistical significance for pulmonary complications after HSCT. The mortality rates from pulmonary complications following HSCT were high, especially those of viral and fungal pneumonia, diffuse alveolar hemorrhage and idiopathic pneumonia syndrome.

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“…Careful inclusion and exclusion of patients with early detection of infection would probably reduce transplant‐related mortality of PBSCT. Aggressive treatment is necessary whenever infection is suspected during the neutropenia period 22 . It is very important to enforce strict patient enrolment since the risk of transplantation might outweigh the benefit in the patient with severe organ dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Treatment and follow‐up of 18 severe systemic lupus erythematosus patients with stem cell transplantation

Leng

Zhao

Zhou

et al. 2006

APLAR Journal of Rheumatology

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Aim: To investigate the feasibility, efficacy and safety of high‐dose immunosuppressive therapy and autologous peripheral blood stem cell transplantation (PBSCT) with CD34+ cell selection in patients with refractory and severe autoimmune diseases. Methods: Eighteen patients with persistent systemic lupus erythematosus refractory to conventional treatment were enrolled into the study of peripheral blood stem cell transplantation in Peking Union Medical College Hospital from 1999 to 2005. After mobilization and conditioning, the enriched CD34+ cells were reinfused. Disease activity, adverse effects, haematopoietic and immunologic reconstitution were monitored and followed up for at least 6 months. Results: Overall treatment‐related mortality was 5.6% with one patient dying of cytomegalovirus infection. The overall remission rate was 95.8% in the first year after PBSCT. Relapse occurred in three patients (17.6%) in 37, 26, and 19 months post‐transplantation, respectively. Disease Activity Index scores of systemic lupus erythematosus survivors were decreased significantly (P < 0.001). Conclusions: Short‐term effect of autologous peripheral blood stem cell transplantation is promising although treatment‐related mortality and relapses are observed in a subset of patients. High‐dose immunosuppressive therapy followed by autologous peripheral blood stem cell transplantation with CD34+ cell selection is feasible and relatively safe in the treatment of severe and refractory autoimmune diseases. The long‐term effect needs further evaluation and multicentre study.

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Immune reconstitution after hematopoietic stem-cell transplantation and its influence on respiratory infections1

Cited by 17 publications

References 0 publications

Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation

Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation

Pulmonary Complications After Hematopoietic Stem Cell Transplantation

Treatment and follow‐up of 18 severe systemic lupus erythematosus patients with stem cell transplantation

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