Strategies for prevention of infectious complications in children after HSCT in relation to type of transplantation and GVHD occurrence

Abstract

Summary Background Infectious complications are a major cause of morbidity and mortality in paediatric and adult patients undergoing haematopoietic stem cell transplantation (HSCT). Aim Analysis of strategies for prevention of infectious complications in children after HSCT in relation to the type of transplantation and GVHD occurrence. Materials/Methods A review of PubMed references based on evidence-based recommendations rated by the strength of the recommendation and the quality of the supporting evidence. The risk of infection was divided into: low for autologous HSCT, moderate for MSD-HSCT without GVHD, and high for unrelated, mismatched, haploidentical HSCT, cord blood HSCT, patients with moderate-to-severe GVHD, undergoing immunosuppressive treatment, CMV infection, ex vivo T-cell depletion or CD34 selection and in vivo T-cell depletion. Results Prophylaxis strategy includes general infection control in hospital environment and pharmacological approach, related to antibacterial, antifungal and antiviral agents. Most studies were done on adult patients only, while some included both paediatric and adults patients. However, no differences in prophylaxis strategy and efficacy between age groups were reported in these studies. Recommendations for use of specific drugs in prophylaxis in transplantation period and recommendations for vaccination are presented in this paper. Conclusions With changing practices, transplant teams are encouraged to review local patterns of infections and associated complications and communicate regularly with infection control committees for guidance on the evolution of isolation needs for the immunosuppressed patient before and after HSCT.