Severe infections after bone marrow transplantation

Abstract

Bone marrow transplantation and stem cell transplantation have become standard therapies offering potential cures for a number of hematologic malignancies and immunologic disorders. Severe infection remains a life threatening complication after transplantation, contributes significantly to morbidity, and may necessitate admission to the ICU. It is estimated that between 20 and 40% of patients receiving bone marrow transplant will require ICU admission in the initial posttransplantation phase. Historically, survival rates after admission to the ICU are dismal, particularly if mechanical ventilation is required for respiratory failure. Other organ involvement worsens the prognosis still further and has led to proposals for rationing or restricting access to critical care units and supportive measures. Recent studies have reported small but significant improvements in outcome after critical illness. Whether this improvement is a result of changes in levels of supportive care or a more defined patient selection is uncertain. Moreover, risk factors identifying patients who will benefit most from intensive support are poorly defined. However, it is generally accepted that respiratory failure requiring invasive mechanical ventilation is associated with a poor prognosis in this patient group. Early involvement of intensivists in the management of critical illness in transplant recipients is likely to continue to improve survival in this group of patients.

Outcomes for critically ill patients with haematological malignancies in specialist and non-specialist centres in the United Kingdom

“…Survival rates may be increasing however since recent data demonstrate hospital and one year survival of 54-60% and 43%, respectively [9,10]. Outcomes after haemopoeitic stem cell transplantation (HSCT) appear to be worse [11], although there have been a number of papers suggesting that the prognosis may have improved even among HSCT recipients [12][13][14][15].…”

Modern management of respiratory failure due to pulmonary mycoses following allogeneic hematopoietic stem‐cell transplantation

“…Depending on risk factors, the incidence of invasive fungal infections (IFI) in allogeneic HSCT recipients ranges from 14% to 25% [3,4]. These infections count among the most dangerous complications in the HSCT setting [5,6] being one of the major causes of respiratory failure in this context. Several studies have indicated a very poor outcome with a very high mortality (above 95%) in HSCT patients with respiratory failure requiring artificial ventilation (AV), especially when combined with hepatic and renal dysfunction [6,7].…”

Treatment of refractory myasthenia: “Rebooting” with high‐dose cyclophosphamide

“…Previous experiments in our laboratory using rats with experimental autoimmune MG suggested that complete elimination of the existing immune system and replacement by means of bone marrow transplantation (BMT) could restore the animals to their pristine immunological state, without residual responsiveness to the antigen AChR 7,8 Similar approaches have been tested in a variety of human autoimmune disorders. 9 -13 However, the risks associated with BMT, 14,15 and the fact that the autoimmune disorders recurred in some cases, 16,17 has limited the enthusiasm for these procedures.…”