Einsele Hermann, Bertz Hartmut, Beyer Jörg, Kiehl Michael G, Runde Volker, Kolb Hans-Jochen, Holler Ernst, Beck Robert, Schwerdfeger Rainer, Schumacher Ulrike, Hebart Holger, Martin Hans, Kienast Joachim, Ullmann Andrew J, Maschmeyer Georg, Krüger William, Niederwieser Dietger, Link Hartmut, Schmidt Christian A, Oettle Helmut, Klingebiel Thomas
Dept. of Hematology, Oncology, Medical Clinic II, University of Tübingen, Otfried-Müller-Strasse 10, 72076, Tübingen, Germany.
Ann Hematol. 2003 Oct;82 Suppl 2(Suppl 2):S175-85. doi: 10.1007/s00277-003-0772-4. Epub 2003 Sep 10.
The risk of infection after allogeneic stem cell transplantation is determined by the underlying disease, the intensity of previous treatments and complications that may have occurred during that time, but above all, the risk of infection is determined by the selected transplantation modality (e.g. HLA-match between the stem cell donor and recipient, T cell depletion of the graft, and others). In comparison with patients treated with high-dose chemotherapy and autologous stem cell transplantation, patients undergoing allogeneic stem cell transplantation are at a much higher risk of infection even after hematopoietic reconstitution, due to the delayed recovery of T and B cell functions. The rate at which immune function recovers after hematopoietic reconstitution greatly influences the incidence and type of post-transplant infectious complications. Infection-associated mortality, for example, is significantly higher following engraftment than during the short neutropenic period that immediately follows transplantation.
异基因造血干细胞移植后的感染风险取决于基础疾病、既往治疗的强度以及在此期间可能发生的并发症,但最重要的是,感染风险取决于所选的移植方式(例如干细胞供体与受体之间的HLA匹配、移植物的T细胞清除等)。与接受大剂量化疗和自体造血干细胞移植的患者相比,接受异基因造血干细胞移植的患者即使在造血重建后,由于T和B细胞功能恢复延迟,感染风险也高得多。造血重建后免疫功能恢复的速度极大地影响移植后感染并发症的发生率和类型。例如,移植后感染相关死亡率在植入后明显高于移植后紧接着的短时间中性粒细胞减少期。