Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Handb Clin Neurol. 2024;202:135-151. doi: 10.1016/B978-0-323-90242-7.00010-9.
As autologous stem cell transplantation (ASCT) is increasingly frequent in some patients with multiple sclerosis (MS), the knowledge of its adverse effects is paramount. Early complications (within 30 from transplantation) are usually due to conditioning regimen and consequent neutropenia. They include infections and noninfectious complications, such as oral and intestinal mucositis, increases in liver enzymes, hemorrhagic cystitis, and worsening of neurologic symptoms. Infections in the early phase, particularly during neutropenia, are mainly of bacterial origin, such as bloodstream infections, pneumonia, central-venous catheter-related infections, urinary infections, and neutropenic typhlitis, followed by viral reactivations. Prophylaxis with acyclovir against reactivation of herpes simplex virus (HSV) and varicella-zoster virus (VZV) is recommended, while a preemptive strategy is used for cytomegalovirus (CMV) and Epstein-Barr virus (EBV) management. Fungal infections are infrequent and mainly caused by Candida, thus fluconazole prophylaxis is used in some centers. Late complications include secondary autoimmune diseases: hematologic, such as immune thrombocytopenic purpura, autoimmune hemolytic anemia, or acquired hemophilia, or nonhematologic, such as thyroiditis, rheumatoid arthritis, or Crohn's disease. Other late complications are endocrinopathies and gonadal dysfunction with possible consequences on fertility. Particularly in women over 32 years of age, the risk of infertility and premature ovarian insufficiency can be significant. Thus, reproductive counseling with fertility preservation techniques if required is mandatory before ASCT.
随着自体干细胞移植（ASCT）在一些多发性硬化症（MS）患者中的应用越来越频繁，了解其不良反应至关重要。早期并发症（移植后 30 天内）通常是由于预处理方案和随之而来的中性粒细胞减少引起的。它们包括感染和非感染性并发症，如口腔和肠道黏膜炎、肝酶升高、出血性膀胱炎和神经症状恶化。早期的感染，特别是在中性粒细胞减少期间，主要是细菌感染，如血流感染、肺炎、中心静脉导管相关感染、尿路感染和中性粒细胞减少性结肠炎，随后是病毒再激活。建议使用阿昔洛韦预防单纯疱疹病毒（HSV）和水痘带状疱疹病毒（VZV）的再激活，而对于巨细胞病毒（CMV）和 EBV，则采用抢先策略进行管理。真菌感染较为罕见，主要由念珠菌引起，因此一些中心使用氟康唑预防。晚期并发症包括继发性自身免疫性疾病：血液系统疾病，如免疫性血小板减少性紫癜、自身免疫性溶血性贫血或获得性血友病，或非血液系统疾病，如甲状腺炎、类风湿关节炎或克罗恩病。其他晚期并发症是内分泌疾病和性腺功能障碍，可能对生育能力产生影响。特别是对于 32 岁以上的女性，不孕和卵巢早衰的风险可能很大。因此，在 ASCT 前必须进行生殖咨询并保留生育能力。
