Chapter 108. Hematopoietic Cell Transplantation (Part 7)

Pneumocystis jiroveci pneumonia, once seen in 5–10% of patients, can be prevented by treating patients with oral trimethoprim-sulfamethoxazole for 1 week pretransplant and resuming the treatment once patients have engrafted.The risk of infection diminishes considerably beyond 3 months after transplant unless chronic Most GVHD transplant develops, centers requiring recommend continuous continuingimmunosuppression.trimethoprim-sulfamethoxazole prophylaxis while patients are receiving any immunosuppressive drugs and also recommend careful monitoring for late CMV reactivation. In addition, many centers recommend prophylaxis against varicella zoster, using acyclovir for 1 year posttransplant.Treatment TransplantationofSpecificDiseasesUsingHematopoieticCellNonmalignant Diseases: TreatmentImmunodeficiency Disorders By replacing abnormal stem cells with cells from a normal donor, hematopoietic...
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Chapter 108. Hematopoietic Cell Transplantation (Part 7) Chapter 108. Hematopoietic Cell Transplantation (Part 7) Pneumocystis jiroveci pneumonia, once seen in 5–10% of patients, can beprevented by treating patients with oral trimethoprim-sulfamethoxazole for 1 weekpretransplant and resuming the treatment once patients have engrafted. The risk of infection diminishes considerably beyond 3 months aftertransplant unless chronic GVHD develops, requiring continuousimmunosuppression. Most transplant centers recommend continuingtrimethoprim-sulfamethoxazole prophylaxis while patients are receiving anyimmunosuppressive drugs and also recommend careful monitoring for late CMVreactivation. In addition, many centers recommend prophylaxis against varicellazoster, using acyclovir for 1 year posttransplant. Treatment of Specific Diseases Using Hematopoietic CellTransplantation Nonmalignant Diseases: Treatment Immunodeficiency Disorders By replacing abnormal stem cells with cells from a normal donor,hematopoietic cell transplantation can cure patients of a variety ofimmunodeficiency disorders including severe combined immunodeficiency,Wiskott-Aldrich syndrome, and Chédiak-Higashi syndrome. The widestexperience has been with severe combined immunodeficiency disease, where curerates of 90% can be expected with HLA-identical donors and success rates of 50–70% have been reported using haplotype-mismatched parents as donors (Table108-3). Table 108-3 Estimated 5-Year Survival Rates FollowingTransplantationa Disease Allogeneic, Autologous, % % Severe combined 90 N/Aimmunodeficiency Aplastic anemia 90 N/A Thalassemia 90 N/A Acute myeloid leukemia First remission 55–60 50 Second remission 40 30 Acute lymphocytic leukemia First remission 50 40 Second remission 40 30 Chronic myeloid leukemia Chronic phase 70 ID Accelerated phase 40 ID Blast crisis 15 ID Chronic lymphocytic leukemia 50 ID Myelodysplasia 45 ID Multiple myeloma 30 35 Non-Hodgkins lymphoma First relapse/second remission 40 40 Hodgkins disease First relapse/second 40 50remission Breast cancer High-risk stage II N/A 70 Stage IV N/A 15 a These estimates are generally based on data reported by the InternationalBone Marrow Transplant Registry. The analysis has not been reviewed by theirAdvisory Committee. Note: N/A, not applicable; ID, insufficient data.