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Introduction
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This chapter starts by explaining that the goal of allogeneic stem cell transplantation is the establishment of donor hematopoiesis and immunity in the recipient to treat an antecedent marrow failure disorder or to achieve a graft-versus-cancer effect to treat a neoplastic disease. The goal of autologous hematopoietic stem cell transplant (HSCT) is very different from allogeneic HSCT. In autologous HSCT, the goal of the graft is simpler: it is to rescue the myelotoxic effects of high-dose chemotherapy. Neutropenia is shorter, cellular immunodeficiency is less profound, and immune reconstitution is quicker. Infectious exposures before transplant play an important role after transplant. Although an infection may be effectively treated and under good control before transplant, reactivation may occur after transplant. The search for risk factors that can identify individuals at greatest risk for various types of infection has led to the identification of neutropenia, lymphopenia (or low CD4+ cell counts), low levels of immunoglobulin, and GVHD, prior infection by organisms that may persist in the recipient or donor, and a number of other factors in certain situations. The chapter concludes that one of the biggest challenges is distinguishing infection from some other noninfectious etiology of a syndrome.
Title: Introduction
Description:
This chapter starts by explaining that the goal of allogeneic stem cell transplantation is the establishment of donor hematopoiesis and immunity in the recipient to treat an antecedent marrow failure disorder or to achieve a graft-versus-cancer effect to treat a neoplastic disease.
The goal of autologous hematopoietic stem cell transplant (HSCT) is very different from allogeneic HSCT.
In autologous HSCT, the goal of the graft is simpler: it is to rescue the myelotoxic effects of high-dose chemotherapy.
Neutropenia is shorter, cellular immunodeficiency is less profound, and immune reconstitution is quicker.
Infectious exposures before transplant play an important role after transplant.
Although an infection may be effectively treated and under good control before transplant, reactivation may occur after transplant.
The search for risk factors that can identify individuals at greatest risk for various types of infection has led to the identification of neutropenia, lymphopenia (or low CD4+ cell counts), low levels of immunoglobulin, and GVHD, prior infection by organisms that may persist in the recipient or donor, and a number of other factors in certain situations.
The chapter concludes that one of the biggest challenges is distinguishing infection from some other noninfectious etiology of a syndrome.
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