Chapter 108. Hematopoietic Cell Transplantation (Part 7)

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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 continuing immunosuppression. 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 Transplantation of Specific Diseases Using Hematopoietic Cell Nonmalignant Diseases: Treatment Immunodeficiency Disorders By replacing abnormal stem cells with cells from a normal donor, hematopoietic...

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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 GVHD develops, requiring continuous immunosuppression. Most transplant centers recommend continuing 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 of Specific Diseases Using Hematopoietic Cell Transplantation 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 of immunodeficiency disorders including severe combined immunodeficiency, Wiskott-Aldrich syndrome, and Chédiak-Higashi syndrome. The widest experience has been with severe combined immunodeficiency disease, where cure rates of 90% can be expected with HLA-identical donors and success rates of 50– 70% have been reported using haplotype-mismatched parents as donors (Table 108-3). Table 108-3 Estimated 5-Year Survival Rates Following Transplantationa Disease Allogeneic, Autologous, % %
Severe combined 90 N/A immunodeficiency 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-Hodgkin's lymphoma First relapse/second remission 40 40 Hodgkin's disease First relapse/second 40 50 remission
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 International Bone Marrow Transplant Registry. The analysis has not been reviewed by their Advisory Committee. Note: N/A, not applicable; ID, insufficient data.