Special Considerations for Long-Term Survivors After Hematopoietic Stem Cell Transplantation

Abstract

Significant decrease in early mortality after hematopoietic stem cell transplantation (HCT) has resulted in an increasing number of long-term survivors. Long-term transplant survivors are at risk for developing late complications such as chronic graft-versus-host disease (GVHD) and late infections. Late infections with bacteria, viruses, fungi, and other organisms are most common in patients with chronic GVHD and those who received T depleted or cord blood transplants. Evidence based data to guide specific recommendations for duration of infectious prophylaxis beyond 100 days after HCT is limited, and clinical practice is variable and based on type of transplant, GVHD status, immunosuppression therapy, viral serology status pre-transplant of patients and donors, diagnosis at transplant, prior treatment with certain chemotherapeutic agents, and prior history of infections. Special consideration for HCT recipients beyond 100 days after transplant, including recommendations for anti-microbial prophylaxis, based on recent international guidelines, recent literature review, and standard practice at the Fred Hutchinson Cancer Research Center (FHCRC), is discussed in this chapter.