Page 324 - Essential Haematology

310 / Chapter 23 Stem cell transplantation

but other herpes viruses and P. carinii account frequent, especially with encapsulated organisms

for other cases; in most cases, no cause other affecting the respiratory tract. Oral penicillin is
than the previous radiation and chemotherapy given prophylactically to reduce this risk. VZV and

can be implicated. Bronchoalveolar lavage or open fungal infections are also frequent. The use of pro-
lung biopsy may be needed to establish the phylactic co - trimoxazole and oral aciclovir for 3 – 6
diagnosis. months reduces the risk of Pneumocystis and herpes
infections, respectively.
Blood p roduct s upport Delayed pulmonary complications include
Platelet concentrates are given to maintain a restrictive pneumonitis and bronchiolitis obliterans.
9
count of 10 × 10 /L or more. Platelets and Endocrine complications include hypothyroidism,
blood transfusions given in the post - transplant growth failure in children, impaired sexual develop-

period must be irradiated prior to administration in ment and infertility. These endocrine problems are
order to kill any lymphocytes that might cause more marked if TBI has been used. Clinically
GVHD. apparent autoimmune disorders are infrequent
and include myasthenia, rheumatoid arthritis,
anaemia, thrombocytopenia or neutropenia.
Other c omplications of a llogeneic Autoantibodies are frequently detected in the
t ransplantation absence of symptoms. Second malignancies (espe-
cially non - Hodgkin lymphoma) occur with a
Graft f ailure six - or sevenfold incidence compared with controls.
The risk of graft failure is increased if the patient CNS complications include neuropathies and

has aplastic anaemia or if T - cell depletion of donor eye problems caused by chronic GVHD (sicca syn-
marrow is used as GVHD prophylaxis. Th is sug- drome) or cataracts.
gests that donor T cells are needed to overcome host
resistance to engraftment of stem cells.

Graft - v ersus - l eukaemia e ffect and d onor

l eucocyte i nfusions
Haemorrhagic c ystitis
This is usually caused by the cyclophosphamide After allogeneic transplantation the donor immune

metabolite acrolein. Mesna is given in an attempt system helps to eradicate the patient s leukaemia,
’
to prevent this. Certain viruses (e.g. adenovirus or a phenomenon known as the graft - versus -
polyomavirus) may also cause this complication. leukaemia effect. Evidence includes the decreased

relapse rate in patients with GVHD, the increased
Other c omplications relapse rate in identical twins and, most convinc-
These include veno - occlusive disease of the liver ingly, the ability of donor leucocyte infusions to

(manifest as jaundice, hepatomegaly and ascites or cure relapsed leukaemia in some patients. Graft -
weight gain) and cardiac failure as a result of the versus - lymphoma and graft - versus - myeloma eff ects

conditioning regimen (especially high doses of also exist. The principle of DLI is that peripheral
cyclophosphamide) and previous chemotherapy on blood mononuclear cells are collected from the
the heart. Haemolysis because of ABO incompati- original allograft donor and directly infused into
bility between donor and recipient may cause prob- the patient at the time of leukaemia relapse

lems in the first weeks. Microangiopathic haemolytic (Fig. 23.11 ).

anaemia may also occur. There is a large difference in the outcome of
different diseases treated by DLI. Chronic myeloid

leukaemia (CML) is most sensitive whereas acute
Late c omplications
lymphoblastic leukaemia rarely responds. In CML
Relapse of the original disease (e.g. acute or chronic the response to DLI is better in cases of early
leukaemia) may occur. Bacterial infections are relapse. PCR is used to monitor serial blood