Stem cell transplant complications - Revision history

Elcatracho: /* See Also */

2021-03-08T19:56:32Z

ClaireLewis at 18:33, 1 October 2019

2019-10-01T18:33:05Z

← Older revision		Revision as of 18:33, 1 October 2019
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	*Infection		*Infection
	**[[Aspergillus]] (main cause), [[CMV]], [[HSV]], [[Toxoplasma]], [[Candida]], [[Cryptococcus]], bacterial [[meningitis]]		**[[Aspergillus]] (main cause), [[CMV]], [[HSV]], [[Toxoplasma]], [[Candida]], [[Cryptococcus]], bacterial [[meningitis]]
	*Metabolic ~~Encephalopathy~~		*Metabolic [[encephalopathy]]
	**Causes include hypoxemia, electrolyte abnormalities, [[metabolic acidosis]], [[sepsis]], [[hepatic failure]], medications (sedatives and analgesics), thiamine deficiency		**Causes include [[hypoxemia]], [[electrolyte abnormalities]], [[metabolic acidosis]], [[sepsis]], [[hepatic failure]], medications ([[sedatives]] and [[analgesia\|analgesics]]), [[thiamine deficiency]]
	===Cardiac complications===		===Cardiac complications===
	*[[Pulmonary edema]]		*[[Pulmonary edema]]
	**Risk factors: low EF, ~~venooclussive~~ disease, severe sepsis, anemia, high-dose chemo		**Risk factors: low EF, veno-oclussive disease, severe [[sepsis]], [[anemia]], high-dose chemo
	*[[Pericardial effusion]], [[pericardial tamponade]]		*[[Pericardial effusion]], [[pericardial tamponade]]
	**Rare, associated with [[cyclophosphamide]] toxicity, infection, chronic [[GVHD]], renal failure		**Rare, associated with [[cyclophosphamide]] toxicity, infection, chronic [[GVHD]], [[renal failure]]
	===Pulmonary complications===		===Pulmonary complications===
	*Engraftment syndrome		*Engraftment syndrome
	**Due to rapid return of neutrophils		**Due to rapid return of neutrophils
	**Features: [[fever]], rash, pulmonary edema, weight gain, liver and renal dysfunction, and/or encephalopathy		**Features: [[fever]], [[rash]], [[pulmonary edema]], weight gain, [[hepatic failure\|liver]] and [[AKI\|renal dysfunction]], and/or [[encephalopathy]]
	*[[Diffuse alveolar hemorrhage]]		*[[Diffuse alveolar hemorrhage]]
	*Bronchiolitis obliterans with or without organizing pneumonia		*Bronchiolitis obliterans with or without organizing pneumonia
	===GI complications===		===GI complications===
	*Intestinal [[GVHD]]		*Intestinal [[GVHD]]
	**abdominal pain, nausea/vomiting, diarrhea, GI bleeding +/- peritonitis, hepatitis, rash		**[[abdominal pain]], [[nausea/vomiting]], [[diarrhea]], [[GI bleeding]] +/- [[peritonitis]], [[hepatitis]], [[rash]]
	*Pseudo-obstruction		*Pseudo-[[SBO\|obstruction]]
	*Veno-occlusive disease of liver		*Veno-occlusive disease of liver
	**common		**common
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	**[[RUQ pain]], [[jaundice]], weight gain		**[[RUQ pain]], [[jaundice]], weight gain
	*[[GI bleed]]		*[[GI bleed]]
	**Chemo, GVHD, or CMV/adenovirus → diffuse mucosal bleeding, ulcers, or necrosis		**Chemo, [[GVHD]], or [[CMV]]/[[adenovirus]] → diffuse mucosal bleeding, ulcers, or necrosis
	===Renal complications===		===Renal complications===
	*[[Tumor lysis syndrome]]		*[[Tumor lysis syndrome]]
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	===[[Graft-vs-host disease]]===		===[[Graft-vs-host disease]]===
	*Acute (<100 days post-transplant) or chronic		*Acute (<100 days post-transplant) or chronic
	*rash, mucositis, diarrhea, fever, +/- hepatitis, polyneuropathy, ~~polymyositis~~, GI bleed, pancreatitis		*[[rash]], mucositis, [[diarrhea]], [[fever]], +/- [[hepatitis]], polyneuropathy, poly[[myositis]], [[GI bleed]], [[pancreatitis]]
	===Infection===		===[[Infection]]===
	'''See also [[neutropenic fever]] and [[Immunocompromised antibiotics]]		'''See also [[neutropenic fever]] and [[Immunocompromised antibiotics]]
	*Viral		*Viral
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	**[[RSV]]		**[[RSV]]
	**[[Adenovirus]]		**[[Adenovirus]]
	**HHV-6: pneumonitis, bone marrow suppression, enteritis, encephalitis		**HHV-6: [[pneumonitis]], bone marrow suppression, enteritis, [[encephalitis]]
	**[[HSV]]: pneumonia, hepatitis, rash, encephalitis, DIC		**[[HSV]]: [[pneumonia]], [[hepatitis]], [[rash]], [[viral encephalitis\|encephalitis]], [[DIC]]
	*Bacterial		*Bacterial
	**increased risk due to neutropenia, mucositis, skin fragility, GI problems, indwelling lines		**increased risk due to [[neutropenia]], mucositis, skin fragility, GI problems, indwelling lines
	**[[Pseudomonas]], [[klebsiella]]		**[[Pseudomonas]], [[klebsiella]]
	**[[MRSA]], [[strep viridans]], [[enterococcus]]		**[[MRSA]], [[strep viridans]], [[enterococcus]]
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	**Pneumonia, [[endocarditis]], [[UTI]], colitis, meningitis, etc.		**Pneumonia, [[endocarditis]], [[UTI]], colitis, meningitis, etc.
	*Fungal		*Fungal
	**[[Aspergillus]]: pulmonary, hepatic, endocarditis, CNS infection (main cause of CNS infection)		**[[Aspergillus]]: pulmonary, hepatic, [[endocarditis]], CNS infection (main cause of CNS infection)
	**[[Candida]]: pneumonia, hepatic, CNS infection, endophthalmitis, esophagitis		**[[Candida]]: [[pneumonia]], hepatic, CNS infection, [[endophthalmitis]], [[esophageal candidiasis\|esophagitis]]
	**[[Pneumocystis]]: pneumonia		**[[Pneumocystis]]: [[PCP pneumonia\|pneumonia]]
	**[[Cryptococcus]]: CNS, pneumonia		**[[Cryptococcus]]: [[meningitis\|CNS]], [[pneumonia]]
	*[[Toxoplasmosis]]: CNS infection, pneumonia		*[[Toxoplasmosis]]: CNS infection, pneumonia
	*Causative organisms by time after transplant:		*Causative organisms by time after transplant:
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	===Treatment adverse effects===		===Treatment adverse effects===
	*[[Prednisone]]		*[[Prednisone]]
	**Hyperglycemia, psychiatric symptoms, poor wound healing, edema, hypertension, ulcers		**[[Hyperglycemia]], psychiatric symptoms, poor wound healing, edema, [[hypertension]], ulcers
	*[[Tacrolimus]], [[cyclosporine]]		*[[Tacrolimus]], [[cyclosporine]]
	**Neurotoxicity, tremor, hyperkalemia, nephrotoxicity, hypertension, hyperglycemia, gout, cardiotoxicity		**Neurotoxicity, [[tremor]], [[hyperkalemia]], [[nephrotoxicity]], [[hypertension]], [[hyperglycemia]], [[gout]], cardiotoxicity
	*[[Mycophenolate mofetil]], [[methotrexate]]		*[[Mycophenolate mofetil]], [[methotrexate]]
	**Cytopenias, GI distress		**Cytopenias, GI distress
	*[[Azathioprine]]		*[[Azathioprine]]
	**Cytopenias, pancreatitis, hepatitis		**Cytopenias, [[pancreatitis]], [[hepatitis]]
	*Also consider toxicities related to other medications, including prophylactic or broad spectrum antibiotics		*Also consider toxicities related to other medications, including prophylactic or broad spectrum antibiotics

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	*See [[immunocompromised antibiotics]], [[neutropenic fever]]		*See [[immunocompromised antibiotics]], [[neutropenic fever]]
	*See [[thrombocytopenia]], [[anemia]]		*See [[thrombocytopenia]], [[anemia]]
	**Patients should ~~recieve~~ leukocyte-reduced/irradiated PRBCs		**Patients should receive leukocyte-reduced/irradiated PRBCs
	*See [[Graft-vs-host disease]]		*See [[Graft-vs-host disease]]
	**Treatment usually glucocorticoids		**Treatment usually [[glucocorticoids]]
	*Low threshold to consult heme/onc, infectious disease		*Low threshold to consult heme/onc, infectious disease

Mholtz: Text replacement - "-->" to "→"

2017-02-08T18:17:36Z

Text replacement - "-->" to "→"

← Older revision		Revision as of 18:17, 8 February 2017
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	**common		**common
	**usually first 21 days after transplant		**usually first 21 days after transplant
	**high dose ~~chemo-->endothelial~~ damage of central hepatic ~~venules-->~~ thrombosis		**high dose chemo→endothelial damage of central hepatic venules→ thrombosis
	**[[RUQ pain]], [[jaundice]], weight gain		**[[RUQ pain]], [[jaundice]], weight gain
	*[[GI bleed]]		*[[GI bleed]]
	**Chemo, GVHD, or CMV/adenovirus ~~-->~~ diffuse mucosal bleeding, ulcers, or necrosis		**Chemo, GVHD, or CMV/adenovirus → diffuse mucosal bleeding, ulcers, or necrosis
	===Renal complications===		===Renal complications===
	*[[Tumor lysis syndrome]]		*[[Tumor lysis syndrome]]

ClaireLewis: /* Background */

2016-10-05T05:03:09Z

Background

← Older revision		Revision as of 05:03, 5 October 2016
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	*Cells harvested from bone marrow or peripherally		*Cells harvested from bone marrow or peripherally
	*Treats various malignant and benign heme/onc diseases		*Treats various malignant and benign heme/onc diseases
	**[[Leukemia]], [[lymphoma]], [[multiple myeloma]], myelodysplastic ~~syndromes~~		**[[Leukemia]], [[lymphoma]], [[multiple myeloma]], [[myelodysplastic syndrome]]
	**Severe [[aplastic anemia]] and bone marrow failure, inherited blood dyscrasias or immune deficiencies		**Severe [[aplastic anemia]] and bone marrow failure, inherited blood dyscrasias or immune deficiencies
	*Phases of recipient transplant process		*Phases of recipient transplant process

ClaireLewis: /* References */

2016-09-29T02:39:50Z

References

← Older revision		Revision as of 02:39, 29 September 2016
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	<references/>		<references/>

	[[Category:Heme/~~onc~~]]		[[Category:Heme/Onc]]

ClaireLewis: /* Treatment adverse effects */

2016-09-29T02:38:59Z

Treatment adverse effects

← Older revision		Revision as of 02:38, 29 September 2016
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	===Treatment adverse effects===		===Treatment adverse effects===
	*Prednisone		*[[Prednisone]]
	**Hyperglycemia, psychiatric symptoms, poor wound healing, edema, hypertension, ulcers		**Hyperglycemia, psychiatric symptoms, poor wound healing, edema, hypertension, ulcers
	*Tacrolimus, cyclosporine		*[[Tacrolimus]], [[cyclosporine]]
	**Neurotoxicity, tremor, hyperkalemia, nephrotoxicity, hypertension, hyperglycemia, gout, cardiotoxicity		**Neurotoxicity, tremor, hyperkalemia, nephrotoxicity, hypertension, hyperglycemia, gout, cardiotoxicity
	*Mycophenolate, methotrexate		*[[Mycophenolate mofetil]], [[methotrexate]]
	**Cytopenias, GI distress		**Cytopenias, GI distress
	*Azathioprine		*[[Azathioprine]]
	**Cytopenias, pancreatitis, hepatitis		**Cytopenias, pancreatitis, hepatitis
	*~~Toxicity~~ related to broad spectrum antibiotics		*Also consider toxicities related to other medications, including prophylactic or broad spectrum antibiotics

	==Evaluation==		==Evaluation==

ClaireLewis: /* Infection */

2016-09-29T02:37:38Z

Infection

← Older revision		Revision as of 02:37, 29 September 2016
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	**[[CMV]]: pneumonitis most fatal, can also cause CNS infection, retinitis, hepatitis, pancreatitis, esophagitis, colitis		**[[CMV]]: pneumonitis most fatal, can also cause CNS infection, retinitis, hepatitis, pancreatitis, esophagitis, colitis
	**[[RSV]]		**[[RSV]]
	**Adenovirus		**[[Adenovirus]]
	**HHV-6: pneumonitis, bone marrow suppression, enteritis, encephalitis		**HHV-6: pneumonitis, bone marrow suppression, enteritis, encephalitis
	**HSV: pneumonia, hepatitis, rash, encephalitis, DIC		**[[HSV]]: pneumonia, hepatitis, rash, encephalitis, DIC
	*Bacterial		*Bacterial
	**increased risk due to neutropenia, mucositis, skin fragility, GI problems, indwelling lines		**increased risk due to neutropenia, mucositis, skin fragility, GI problems, indwelling lines
	**[[Pseudomonas]], [[klebsiella]]		**[[Pseudomonas]], [[klebsiella]]
	**[[MRSA]], strep viridans, ~~enterococci~~		**[[MRSA]], [[strep viridans]], [[enterococcus]]
	**[[C. diff]]		**[[C. diff]]
	**Pneumonia, [[endocarditis]], [[UTI]], colitis, meningitis, etc.		**Pneumonia, [[endocarditis]], [[UTI]], colitis, meningitis, etc.
	*Fungal		*Fungal
	**Aspergillus: pulmonary, hepatic, endocarditis, CNS infection (main cause of CNS infection)		**[[Aspergillus]]: pulmonary, hepatic, endocarditis, CNS infection (main cause of CNS infection)
	**[[Candida]]: pneumonia, hepatic, CNS infection, endophthalmitis, esophagitis		**[[Candida]]: pneumonia, hepatic, CNS infection, endophthalmitis, esophagitis
	**[[Pneumocystis ~~jirovecii~~]]: pneumonia		**[[Pneumocystis]]: pneumonia
	**[[Cryptococcus]]: CNS, pneumonia		**[[Cryptococcus]]: CNS, pneumonia
	*[[Toxoplasmosis]]: CNS infection, pneumonia		*[[Toxoplasmosis]]: CNS infection, pneumonia
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	**mid (30-100 days): CMV, PCP, adenovirus, HSV, aspergillus		**mid (30-100 days): CMV, PCP, adenovirus, HSV, aspergillus
	**late (>100 days): CMV		**late (>100 days): CMV

	===Treatment adverse effects===		===Treatment adverse effects===
	*Prednisone		*Prednisone

ClaireLewis: Created page with "==Background== Autologous or allogenic Cells harvested from bone marrow or peripherally *Treats various malignant and benign heme/onc diseases **Leukemia, lymphoma,..."

2016-09-29T02:33:16Z

Created page with "==Background== *Autologous or allogenic *Cells harvested from bone marrow or peripherally *Treats various malignant and benign heme/onc diseases **Leukemia, lymphoma,..."

New page

==Background==
*Autologous or allogenic
*Cells harvested from bone marrow or peripherally
*Treats various malignant and benign heme/onc diseases
**[[Leukemia]], [[lymphoma]], [[multiple myeloma]], myelodysplastic syndromes
**Severe [[aplastic anemia]] and bone marrow failure, inherited blood dyscrasias or immune deficiencies
*Phases of recipient transplant process
**Conditioning with radiation (usually total body) and/or chemotherapy
***Goals: eliminate underlying malignancy, prevent rejection
**Infusion
**Neutropenic phase (weeks 2-4): no functioning immune system
**Engraftment phase: highest risk of acute [[GVHD]], lasts several weeks
**Post-engraftment phase

==Clinical Features/Differential==
===Neurologic complications===
''Higher risk with allogenic transplant''
*[[Stroke]]
**Median time of presentation 28 days post-transplant
**Usually hemorrhagic due to [[thrombocytopenia]]
**Can also be ischemic due infection, thrombosis, endocarditis
*Infection
**[[Aspergillus]] (main cause), [[CMV]], [[HSV]], [[Toxoplasma]], [[Candida]], [[Cryptococcus]], bacterial [[meningitis]]
*Metabolic Encephalopathy
**Causes include hypoxemia, electrolyte abnormalities, [[metabolic acidosis]], [[sepsis]], [[hepatic failure]], medications (sedatives and analgesics), thiamine deficiency
===Cardiac complications===
*[[Pulmonary edema]]
**Risk factors: low EF, venooclussive disease, severe sepsis, anemia, high-dose chemo
*[[Pericardial effusion]], [[pericardial tamponade]]
**Rare, associated with [[cyclophosphamide]] toxicity, infection, chronic [[GVHD]], renal failure
===Pulmonary complications===
*Engraftment syndrome
**Due to rapid return of neutrophils
**Features: [[fever]], rash, pulmonary edema, weight gain, liver and renal dysfunction, and/or encephalopathy
*[[Diffuse alveolar hemorrhage]]
*Bronchiolitis obliterans with or without organizing pneumonia
===GI complications===
*Intestinal [[GVHD]]
**abdominal pain, nausea/vomiting, diarrhea, GI bleeding +/- peritonitis, hepatitis, rash
*Pseudo-obstruction
*Veno-occlusive disease of liver
**common
**usually first 21 days after transplant
**high dose chemo-->endothelial damage of central hepatic venules--> thrombosis
**[[RUQ pain]], [[jaundice]], weight gain
*[[GI bleed]]
**Chemo, GVHD, or CMV/adenovirus --> diffuse mucosal bleeding, ulcers, or necrosis
===Renal complications===
*[[Tumor lysis syndrome]]
*Hemorrhagic cystitis, veno-occlusive disease
*[[Hemolytic uremic syndrome]]
===[[Graft-vs-host disease]]===
*Acute (<100 days post-transplant) or chronic
*rash, mucositis, diarrhea, fever, +/- hepatitis, polyneuropathy, polymyositis, GI bleed, pancreatitis
===Infection===
'''See also [[neutropenic fever]] and [[Immunocompromised antibiotics]]
*Viral
**[[CMV]]: pneumonitis most fatal, can also cause CNS infection, retinitis, hepatitis, pancreatitis, esophagitis, colitis
**[[RSV]]
**Adenovirus
**HHV-6: pneumonitis, bone marrow suppression, enteritis, encephalitis
**HSV: pneumonia, hepatitis, rash, encephalitis, DIC
*Bacterial
**increased risk due to neutropenia, mucositis, skin fragility, GI problems, indwelling lines
**[[Pseudomonas]], [[klebsiella]]
**[[MRSA]], strep viridans, enterococci
**[[C. diff]]
**Pneumonia, [[endocarditis]], [[UTI]], colitis, meningitis, etc.
*Fungal
**Aspergillus: pulmonary, hepatic, endocarditis, CNS infection (main cause of CNS infection)
**[[Candida]]: pneumonia, hepatic, CNS infection, endophthalmitis, esophagitis
**[[Pneumocystis jirovecii]]: pneumonia
**[[Cryptococcus]]: CNS, pneumonia
*[[Toxoplasmosis]]: CNS infection, pneumonia
*Causative organisms by time after transplant:
**early (<30 days): bacteria, candida, aspergillus, HHV, RSV
**mid (30-100 days): CMV, PCP, adenovirus, HSV, aspergillus
**late (>100 days): CMV
===Treatment adverse effects===
*Prednisone
**Hyperglycemia, psychiatric symptoms, poor wound healing, edema, hypertension, ulcers
*Tacrolimus, cyclosporine
**Neurotoxicity, tremor, hyperkalemia, nephrotoxicity, hypertension, hyperglycemia, gout, cardiotoxicity
*Mycophenolate, methotrexate
**Cytopenias, GI distress
*Azathioprine
**Cytopenias, pancreatitis, hepatitis
*Toxicity related to broad spectrum antibiotics

==Evaluation==
*CBC, BMP, Mg/Phos
*Low threshold for infectious workup
*Additional evaluation dependent on presentation

==Management==
*See [[immunocompromised antibiotics]], [[neutropenic fever]]
*See [[thrombocytopenia]], [[anemia]]
**Patients should recieve leukocyte-reduced/irradiated PRBCs
*See [[Graft-vs-host disease]]
**Treatment usually glucocorticoids
*Low threshold to consult heme/onc, infectious disease

==Disposition==
*Most complications will require admission

==See Also==
*[[Transplant complications]]
*[[Neutropenic fever]], [[immunocompromised antibiotics]]
*[[Graft-vs-host disease]]
*[[Leukemia]], [[lymphoma]], [[multiple myeloma]]

==External Links==

==References==
<references/>

[[Category:Heme/onc]]

← Older revision		Revision as of 19:56, 8 March 2021
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	==See Also==		==See Also==
	*[[Transplant complications]]		*[[Transplant complications]]
	*[[Neutropenic fever]], [[~~immunocompromised~~ antibiotics]]		*[[Neutropenic fever]]
			*[[Immunocompromised antibiotics]]
	*[[Graft-vs-host disease]]		*[[Graft-vs-host disease]]
	*[[Leukemia]], [[lymphoma]], [[multiple myeloma]]		*[[Leukemia]], [[lymphoma]], [[multiple myeloma]]