[Infections following bone marrow transplantation]

Area of Science:

• Hematology
• Infectious Diseases
• Transplantation Medicine

Context:

• Bone marrow transplantation (BMT) is a critical treatment for various hematologic and oncologic conditions.
• Historically, infectious complications posed a significant threat to BMT recipients, leading to high morbidity and mortality.
• Recent advancements in prophylaxis and diagnostics have begun to mitigate these risks.

Purpose:

• To review the evolving landscape of infectious complications following allogeneic and autologous bone marrow transplantation.
• To highlight the impact of prophylactic strategies and early diagnostic interventions on patient outcomes.
• To identify persistent challenges in managing infections post-BMT.

Summary:

• Septicemia remains the most frequent complication (30-40%) during the aplastic phase of BMT.
• Prophylaxis with quinolones has shifted the spectrum towards Gram-positive infections, reducing Gram-negative cases (<10%) and overall mortality.
• Early diagnosis and treatment of cytomegalovirus (CMV) viremia, alongside prophylactic antibiotics for Pneumocystis carinii and pneumococcal infections, have significantly improved outcomes.
• Persistent challenges include diagnosing and treating invasive fungal infections and managing infections in patients with graft-versus-host disease.

Impact:

• Reduced mortality and morbidity associated with infectious complications post-BMT.
• Shift in the etiological profile of infections, necessitating updated treatment guidelines.
• Improved survival rates and quality of life for BMT recipients.
• Identification of critical areas for future research and clinical intervention, particularly fungal infections and GvHD-related complications.