Advances in the management of infectious complications after bone marrow transplantation

An important contribution to the improved survival after bone marrow transplantation (BMT) over the past decade has been the development of strategies to prevent and manage infectious complications. Today, with these advances, deaths from bacterial and fungal infections are uncommon except in the setting of uncontrolled graft-versus-host disease (GVHD) or failure of engraftment. Historically, the major life-threatening pathogens have been viruses, especially the herpesvirus family. However, they too have become less deadly with the introduction of antiviral agents, changes in transfusion strategies, improvements in the control of GVHD, and better diagnostic procedures. With improved detection methods, we now recognize that some complications formerly thought to be due to treatment toxicities are caused by infectious pathogens. We are increasingly recognizing the complex interplay between immunodeficiency, tissue damage, infectious pathogens, and disordered immune responses. This greater knowledge in time should improve our understanding of the biology of BMT as well as result in improved outcomes.