LATE INFECTIONS FOLLOWING ALLOGENEIC BONE-MARROW TRANSPLANTATION - SUGGESTED STRATEGIES FOR PROPHYLAXIS

Bone marrow transplant recipients remain at risk for infections for a variable period of time even after adequate hematologic reconstitution . Late infections are a significant cause of morbidity and can be fata l in 4-15% of these patients. Patients with chronic graft versus host disease (GVHD) and unrelated-donor transplant recipients, even without GVHD, are at particular risk. Most late infections occur in the first post-transplant year, the majority are caused by bacteria, particular ly encapsulated organisms, or herpes group viruses (CMV and VZV) and p resent with cutaneous, sino-pulmonary or systemic involvement. Effecti ve chemoprophylaxis is available only for the encapsulated bacteria (p enicillin or erythromycin) and Pneumocystis carinii (trimethoprim-sulf amethoxazole). Routine use of long-term IV immunoglobulin supplementat ion has not been shown to be effective and may be harmful as it may de lay reconstitution of humoral immunity. Active immunization (pneumococ cal vaccine, influenza vaccine and HiB) can be effective in patients m ore than 6-12 months from transplant who do not have GVHD. In this rev iew we present our experience, a summary of published literature on th e subject of late infections in bone marrow transplant patients and of fer guidelines for preventative strategies.