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Prevention of infections in hematopoietic cell transplant recipients

John R Wingard, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD


Allogeneic hematopoietic cell transplant (HCT) recipients are at increased risk for a variety of infections based upon their degree of immunosuppression and exposures. Autologous HCT recipients are also at increased risk for infection, although to a lesser degree than those who have undergone allogeneic HCT.

The term "hematopoietic cell transplantation" will be used throughout this topic 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 a range of bacterial, fungal, viral, and/or parasitic infections following HCT. Infection in HCT recipients is associated with high morbidity and mortality. Thus, prevention of infection is a major goal, which involves determination of risk, careful selection of donors, prophylactic and/or preemptive antimicrobial therapy, immunization, and additional measures (eg, infection control).

The prevention of certain infections in HCT recipients will be discussed here; prophylaxis of bacterial infections, invasive fungal infections, and viral infections are discussed in greater detail separately. The evaluation for infection before HCT and an overview of infections following HCT are also presented separately. (See "Prophylaxis of infection during chemotherapy-induced neutropenia in high-risk adults" and "Prophylaxis of invasive fungal infections in adult hematopoietic cell transplant recipients" and "Prevention of viral infections in hematopoietic cell transplant recipients" and "Evaluation for infection before hematopoietic cell transplantation" and "Overview of infections following hematopoietic cell transplantation".)


In 2009, guidelines for preventing infectious complications after HCT 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 [1]. Our recommendations are generally in keeping with these guidelines.


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Literature review current through: Sep 2016. | This topic last updated: Oct 17, 2016.
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  1. 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.
  2. 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).
  3. Haddad E, Landais P, Friedrich W, et al. Long-term immune reconstitution and outcome after HLA-nonidentical T-cell-depleted bone marrow transplantation for severe combined immunodeficiency: a European retrospective study of 116 patients. Blood 1998; 91:3646.
  4. Goulmy E, Schipper R, Pool J, et al. Mismatches of minor histocompatibility antigens between HLA-identical donors and recipients and the development of graft-versus-host disease after bone marrow transplantation. N Engl J Med 1996; 334:281.
  5. De Castro N, Neuville S, Sarfati C, et al. Occurrence of Pneumocystis jiroveci pneumonia after allogeneic stem cell transplantation: a 6-year retrospective study. Bone Marrow Transplant 2005; 36:879.
  6. Stern A, Green H, Paul M, et al. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst Rev 2014; :CD005590.
  7. Chandrasekar PH. Real-time polymerase chain reaction for early diagnosis of toxoplasmosis in stem cell transplant recipients: ready for prime time? Clin Infect Dis 2005; 40:79.
  8. Slavin MA, Meyers JD, Remington JS, Hackman RC. Toxoplasma gondii infection in marrow transplant recipients: a 20 year experience. Bone Marrow Transplant 1994; 13:549.
  9. Martino R, Maertens J, Bretagne S, et al. Toxoplasmosis after hematopoietic stem cell transplantation. Clin Infect Dis 2000; 31:1188.
  10. Lim Z, Baker B, Zuckerman M, et al. Toxoplasmosis following alemtuzumab based allogeneic haematopoietic stem cell transplantation. J Infect 2007; 54:e83.
  11. Mele A, Paterson PJ, Prentice HG, et al. Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature. Bone Marrow Transplant 2002; 29:691.
  12. Chandrasekar PH, Momin F. Disseminated toxoplasmosis in marrow recipients: a report of three cases and a review of the literature. Bone Marrow Transplant Team. Bone Marrow Transplant 1997; 19:685.
  13. de Medeiros BC, de Medeiros CR, Werner B, et al. Disseminated toxoplasmosis after bone marrow transplantation: report of 9 cases. Transpl Infect Dis 2001; 3:24.
  14. Martino R, Bretagne S, Einsele H, et al. Early detection of Toxoplasma infection by molecular monitoring of Toxoplasma gondii in peripheral blood samples after allogeneic stem cell transplantation. Clin Infect Dis 2005; 40:67.
  15. Schmidt M, Sonneville R, Schnell D, et al. Clinical features and outcomes in patients with disseminated toxoplasmosis admitted to intensive care: a multicenter study. Clin Infect Dis 2013; 57:1535.
  16. Jurges E, Young Y, Eltumi M, et al. Transmission of toxoplasmosis by bone marrow transplant associated with Campath-1G. Bone Marrow Transplant 1992; 9:65.
  17. López-Duarte M, Insunza A, Conde E, et al. Cerebral toxoplasmosis after autologous peripheral blood stem cell transplantation. Eur J Clin Microbiol Infect Dis 2003; 22:548.
  18. Nakane M, Ohashi K, Tominaga J, et al. Disseminated toxoplasmosis after CD34+-selected autologous peripheral blood stem cell transplantation. Haematologica 2000; 85:334.
  19. Gonzalez-Vicent M, Diaz MA, Sevilla J, Madero L. Cerebral toxoplasmosis following etanercept treatment for idiophatic pneumonia syndrome after autologous peripheral blood progenitor cell transplantation (PBPCT). Ann Hematol 2003; 82:649.
  20. Foot AB, Garin YJ, Ribaud P, et al. Prophylaxis of toxoplasmosis infection with pyrimethamine/sulfadoxine (Fansidar) in bone marrow transplant recipients. Bone Marrow Transplant 1994; 14:241.
  21. Yuen KY, Woo PC. Tuberculosis in blood and marrow transplant recipients. Hematol Oncol 2002; 20:51.
  22. Petersen F, Thornquist M, Buckner C, et al. The effects of infection prevention regimens on early infectious complications in marrow transplant patients: a four arm randomized study. Infection 1988; 16:199.
  23. Siegel JD, Rhinehart E, Jackson M, et al. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007; 35:S65.
  24. Kneifel W, Czech E, Kopp B. Microbial contamination of medicinal plants--a review. Planta Med 2002; 68:5.
  25. Oliver MR, Van Voorhis WC, Boeckh M, et al. Hepatic mucormycosis in a bone marrow transplant recipient who ingested naturopathic medicine. Clin Infect Dis 1996; 22:521.
  26. Climo MW, Yokoe DS, Warren DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013; 368:533.
  27. Bowden RA, Slichter SJ, Sayers M, et al. A comparison of filtered leukocyte-reduced and cytomegalovirus (CMV) seronegative blood products for the prevention of transfusion-associated CMV infection after marrow transplant. Blood 1995; 86:3598.
  28. Miceli MH, Dong L, Grazziutti ML, et al. Iron overload is a major risk factor for severe infection after autologous stem cell transplantation: a study of 367 myeloma patients. Bone Marrow Transplant 2006; 37:857.
  29. Pullarkat V, Blanchard S, Tegtmeier B, et al. Iron overload adversely affects outcome of allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2008; 42:799.
  30. Spitzer G, Adkins DR, Spencer V, et al. Randomized study of growth factors post-peripheral-blood stem-cell transplant: neutrophil recovery is improved with modest clinical benefit. J Clin Oncol 1994; 12:661.
  31. Klumpp TR, Mangan KF, Goldberg SL, et al. Granulocyte colony-stimulating factor accelerates neutrophil engraftment following peripheral-blood stem-cell transplantation: a prospective, randomized trial. J Clin Oncol 1995; 13:1323.
  32. Demirer T, Ayli M, Dagli M, et al. Influence of post-transplant recombinant human granulocyte colony-stimulating factor administration on peritransplant morbidity in patients undergoing autologous stem cell transplantation. Br J Haematol 2002; 118:1104.
  33. Dekker A, Bulley S, Beyene J, et al. Meta-analysis of randomized controlled trials of prophylactic granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor after autologous and allogeneic stem cell transplantation. J Clin Oncol 2006; 24:5207.
  34. Ringdén O, Labopin M, Gorin NC, et al. Treatment with granulocyte colony-stimulating factor after allogeneic bone marrow transplantation for acute leukemia increases the risk of graft-versus-host disease and death: a study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2004; 22:416.
  35. Raanani P, Gafter-Gvili A, Paul M, et al. Immunoglobulin prophylaxis in hematopoietic stem cell transplantation: systematic review and meta-analysis. J Clin Oncol 2009; 27:770.
  36. Rand KH, Houck H, Ganju A, et al. Pharmacokinetics of cytomegalovirus specific IgG antibody following intravenous immunoglobulin in bone marrow transplant patients. Bone Marrow Transplant 1989; 4:679.
  37. Bosi A, De Majo E, Guidi S, et al. Kinetics of anti-CMV antibodies after administration of intravenous immunoglobulins to bone marrow transplant recipients. Haematologica 1990; 75:109.
  38. Buckley RH, Schiff RI. The use of intravenous immune globulin in immunodeficiency diseases. N Engl J Med 1991; 325:110.
  39. Gathmann B, Mahlaoui N, CEREDIH, et al. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. J Allergy Clin Immunol 2014; 134:116.