Late infections following allogeneic bone marrow transplantation: suggested strategies for prophylaxis.
Late infections following allogeneic bone marrow transplantation: suggested strategies for prophylaxis.
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DOI：
10.3109/10428199709109152
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发表时间：
1997
影响因子：
2.6
通讯作者：
V. Roy;Lorre Ochs;D. Weisdorf
中科院分区：
文献类型：
--
作者：
V. Roy;Lorre Ochs;D. Weisdorf
即使在充分的血液重建后，骨髓移植受者仍有感染的风险。晚期感染是发病的重要原因，并且在这些患者中的4-15%中可能是致命的。患有慢性移植物抗宿主病（GVHD）的患者和无关供体移植受者，即使没有GVHD，也处于特别的风险中。大多数晚期感染发生在移植后的第一年，大多数是由细菌引起的，特别是包囊微生物，或疱疹病毒组（CMV和VZV），并伴有皮肤，鼻窦-肺或全身受累。有效的化学预防仅适用于包囊细菌（青霉素或红霉素）和卡氏肺孢子虫（复方新诺明）。长期静脉注射免疫球蛋白补充剂的常规使用尚未被证明是有效的，并且可能是有害的，因为它可能会延迟体液免疫的重建。主动免疫（肺炎球菌疫苗，流感疫苗和HiB）可以有效的患者超过6-12个月从移植谁没有GVHD。在这篇综述中，我们介绍了我们的经验，总结了已发表的文献中的骨髓移植患者的晚期感染的主题，并提供了预防策略的指导方针。
Bone marrow transplant recipients remain at risk for infections for a variable period of time even after adequate hematologic reconstitution. Late infections are a significant cause of morbidity and can be fatal in 4-15% of these patients. Patients with chronic graft versus host disease (GVHD) and unrelated-donor transplant recipients, even without GVHD, are at particular risk. Most late infections occur in the first post-transplant year, the majority are caused by bacteria, particularly encapsulated organisms, or herpes group viruses (CMV and VZV) and present with cutaneous, sino-pulmonary or systemic involvement. Effective chemoprophylaxis is available only for the encapsulated bacteria (penicillin or erythromycin) and Pneumocystis carinii (trimethoprimsulfamethoxazole). Routine use of long-term I.V. immunoglobulin supplementation has not been shown to be effective and may be harmful as it may delay reconstitution of humoral immunity. Active immunization (pneumococcal vaccine, influenza vaccine and HiB) can be effective in patients more than 6-12 months from transplant who do not have GVHD. In this review we present our experience, a summary of published literature on the subject of late infections in bone marrow transplant patients and offer guidelines for preventative strategies.