Zusammenfassung
Infektionen stellen einen der wichtigsten prognostischen Faktoren für die Überlebenschancen von stammzelltransplantierten Patienten, Kinder und Erwachsenen, dar. Das Auftreten und der Schweregrad der Infektionen sind von der Funktion des Immunsystems im Empfänger abhängig. Die Funktion wird durch den Einsatz immunsuppressiver Medikamente und die Geschwindigkeit der Rekonstitution des Immunsystems nach Transplantation bestimmt. Die Immunrekonstitution kann in die Zeiträume der frühen, mittleren und späten Erholungsphase eingeteilt werden. Die vorliegende Arbeit stellt die Besonderheiten der Infektionsgefährdung innerhalb der jeweiligen Zeiträume nach Stammzelltransplantation (SZT) dar. Die grundlegenden Unterschiede infektiöser Komplikationen sollen zwischen konventionell behandelten bzw. autologen und allogen stammzelltransplantierten onkologischen Patienten im Kindesalter aufgezeigt werden. Hierbei soll neben der Gefährdung in der Aplasie, besonders auf die lang andauernde Immundefizienz nach Transplantation als Risikofaktor für die Entwicklung schwerer Infektionen hingewiesen werden.
Abstract
Infectious complications are a major cause of morbidity and mortality in pediatric and adult patients undergoing hematopoietic stem cell transplantion. The incidence and the severity code of infections depend on the function of the host's immune system. This function is strongly correlated to the application of immune suppressive therapy and the speed of immune reconstitution after stem cell transplantation (SCT). The immune reconstitution can be divided into an early, intermediate and a late phase. This article describes the risk of infections during the different phases of immune reconstitution after stem cell transplantation in children. The basic differences between conventional treated oncologic, autologous and allogenic transplanted children will be presented. Beside the risk in the phase of aplasia there should be pointed out that long term immune deficiency is a strong factor for developing a severe infection after SCT.
Schlüsselwörter
maligne Erkrankungen - Stammzelltransplantation - Infektion - Immunrekonstitution - Kinder
Key words
cancer - stem cell transplantation - infection - immune reconstitution - children
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Dr. med. Friedhelm R. Schuster
Abteilung pädiatrische Onkologie und Hämatologie · Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der Ludwig-Maximilians-Universität München
Lindwurmstr. 4
80337 München
Email: Friedhelm.Schuster@med.uni-muenchen.de
