Hematopoietic support after hematopoietic cell transplantation
- Robert S Negrin, MD
Robert S Negrin, MD
- Section Editor — Bone Marrow Transplantation
- Professor of Medicine
- Stanford University School of Medicine
Autologous and allogeneic hematopoietic cell transplantation (HCT) are associated with neutropenia, anemia, and thrombocytopenia in the peri-transplant period. The degree of myelosuppression and the time to hematopoietic recovery differ with multiple factors including the preparative regimen and graft source. Blood product transfusions and hematopoietic growth factors are essential components of transplant care.
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). Otherwise, the source of such cells will be specified (eg, autologous PBPC transplantation).
Hematopoietic support after HCT will be discussed here. Other supportive care issues surrounding HCT are presented separately, as is quality of life following HCT and acute and chronic graft-versus-host disease (See "Management of the hematopoietic cell transplant recipient in the immediate post-transplant period" and "Quality of life following hematopoietic cell transplantation" and "Prevention of acute graft-versus-host disease" and "Treatment of chronic graft-versus-host disease".)
The diagnosis and treatment of pulmonary, renal, and infectious complications following HCT are also presented separately. (See "Pulmonary complications after allogeneic hematopoietic cell transplantation" and "Pulmonary complications after autologous hematopoietic cell transplantation" and "Kidney disease following hematopoietic cell transplantation" and "Overview of infections following hematopoietic cell transplantation".)
BLOOD PRODUCT SUPPORT
Blood product support is usually required before, during, and following hematopoietic cell transplantation (HCT) . In addition, blood product support, with resulting iron overload, is commonly seen in those patients undergoing HCT for a hematologic disorder. Such iron overload (eg, serum ferritin >1000 ng/mL) may adversely affect overall survival post-HCT, increasing the likelihood of acute graft-versus-host disease, as well as the incidence of blood stream infections and sinusoidal obstruction syndrome of the liver [2-4].
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- BLOOD PRODUCT SUPPORT
- Red blood cell transfusion
- Platelet transfusion
- Granulocyte transfusions
- GROWTH FACTOR SUPPORT
- G-CSF and GM-CSF
- - Autologous HCT
- Autologous PBPC transplantation
- - Allogeneic HCT
- Graft-versus-host disease
- - Allogeneic transplantation
- - Autologous transplantation