Evaluation for infection before hematopoietic cell transplantation
- John R Wingard, MD
John R Wingard, MD
- Professor of Medicine
- University of Florida College of Medicine
The infusion of hematopoietic cells to reestablish marrow function in an individual who has had his or her bone marrow ablated with chemotherapy and/or radiation has become standard therapy for many malignant and nonmalignant diseases. The term "hematopoietic cell transplantation" (HCT) will be used throughout this review as a general term to cover transplantation of progenitor cells from any source (eg, bone marrow, peripheral blood, umbilical cord blood). (See "Sources of hematopoietic stem cells".)
Patients can develop bacterial, fungal, viral, and/or parasitic infections following HCT, particularly following allogeneic HCT (figure 1). Infection in such patients is associated with high morbidity and mortality. Thus, prevention of infection is a major goal involving determination of risk, careful selection of donors, infection control measures, and prophylactic and preemptive antimicrobial therapy.
This topic review will discuss appropriate pretransplantation screening tests. An overview of the infections that can occur in association with HCT and prophylaxis against some of these infections are discussed separately. (See "Overview of infections following hematopoietic cell transplantation" and "Prevention of infections in hematopoietic cell transplant recipients" and "Prophylaxis of invasive fungal infections in adults with hematologic malignancies" and "Prevention of viral infections in hematopoietic cell transplant recipients".)
In 2009, guidelines for preventing infectious complications after hematopoietic cell transplantation were published, which represent the collaboration of several organizations from Europe and North America, including the European Blood and Marrow Transplant Group, the American Society of Blood and Marrow Transplantation, the Canadian Blood and Marrow Transplant Group, the Infectious Diseases Society of America, and the United States Centers for Disease Control and Prevention . Our recommendations are generally in keeping with these guidelines.
The pretransplantation evaluation is designed to prevent posttransplant infections by excluding unsuitable donors and by defining specific infection control policies and antimicrobial prophylaxis and therapy, which will be necessary after transplantation.
- Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009; 15:1143.
- US Food and Drug Administration. Testing HCT/P donors: Specific requirements. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/TissueSafety/ucm151757.htm (Accessed on December 02, 2014).
- Anaissie EJ, Mahfouz TH, Aslan T, et al. The natural history of respiratory syncytial virus infection in cancer and transplant patients: implications for management. Blood 2004; 103:1611.
- Champlin RE, Whimbey E. Community respiratory virus infections in bone marrow transplant recipients: the M.D. Anderson Cancer Center experience. Biol Blood Marrow Transplant 2001; 7 Suppl:8S.
- Fries BC, Riddell SR, Kim HW, et al. Cytomegalovirus disease before hematopoietic cell transplantation as a risk for complications after transplantation. Biol Blood Marrow Transplant 2005; 11:136.
- Milano F, Pergam SA, Xie H, et al. Intensive strategy to prevent CMV disease in seropositive umbilical cord blood transplant recipients. Blood 2011; 118:5689.
- Peck AJ, Corey L, Boeckh M. Pretransplantation respiratory syncytial virus infection: impact of a strategy to delay transplantation. Clin Infect Dis 2004; 39:673.
- Campbell AP, Guthrie KA, Englund JA, et al. Clinical outcomes associated with respiratory virus detection before allogeneic hematopoietic stem cell transplant. Clin Infect Dis 2015; 61:192.
- US Food and Drug Administration. Donor Screening Recommendations to Reduce the Risk of Transmission of Zika Virus by Human Cells, Tissues, and Cellular and Tissue-Based Products: Guidance for Industry, March 2016. http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Tissue/UCM488582.pdf (Accessed on March 07, 2016).
- PRETRANSPLANT EVALUATION
- - Donor
- - Recipient
- Physical examination
- Pathogen-specific testing
- - Endemic pathogens
- - Screening for tuberculosis
- - Community respiratory viruses
- MANAGING INFECTIONS PRIOR TO HCT
- Community respiratory viruses
- Invasive fungal infections
- CONTRAINDICATIONS TO STEM CELL DONATION
- SUMMARY AND RECOMMENDATIONS