Acute phase after haematopoietic stem cell transplantation

Summary

The transplantation of allogeneic or autologous haematopoietic stem cells is an established treatment for many malignant and non-malignant diseases of the bone marrow. Intensive cytoreductive regimens administered before transplantation induce prolonged and severe cytopenia of all haematopoietic lineages. Thrombocytopenia leads to an increased risk of bleeding, which may be further aggravated by consumption of plasmatic factors as a result of tumour lysis or after antibody administration. At the same time, patients after transplantation are also at increased risk of thrombotic complications. Endothelial damage induced by radio-and chemotherapy, indwelling catheters, prolonged immobilization and a high incidence of systemic infection all contribute to the frequent occurrence of thromboembolic events in this population.

This review discusses the incidence and risk factors for haemorrhagic and thrombotic complications after stem cell transplantation. Special emphasis is given to complications occurring specifically in the context of transplantation such as diffuse alveolar haemorrhage, haemorrhagic cystitis, veno-occlusive disease, and transplant associated microangiopathy.

Zusammenfassung

Die Transplantation autologer oder allogener hämatopoietischer Stammzellen ist Routine in der Therapie maligner und nicht maligner Knochenmarkserkrankungen. Die zytoreduktive Therapie vor Transplantation induziert in aller Regel eine schwere und prolongierte Zyto penie aller drei Blutzellreihen. Die Thrombozytopenie führt dabei zu einem erhöhten Risiko von Blutungskomplikationen. Dieses Risiko kann zusätzlich verstärkt werden durch Veränderungen der plasmatischen Gerinnung als Folge einer Tumorlyse oder nach einer Antikörpertherapie. Patienten nach Transplantation erleiden auch häufig thrombotische Komplikationen. Chemo-und Radiotherapie-induzierte Endothelschäden, Venenkatheter, Immobilisation und häufige Infektionen tragen alle zu einem erhöhten Risiko von Thrombosen bei.

Diese Übersichtsarbeit diskutiert die Inzidenz und Risikofaktoren für Blutungs und thrombotische Komplikationen nach Stammzelltransplantation. Dabei wird insbesondere auch auf Komplikationen eingegangen, welche spezifisch nach Transplantation auftreten, wie die diffuse alveoläre Hämorrhagie, die hämorrhagische Zystitis, die Venenverschluss-Krankheit, sowie die Transplantations-assoziierte Mikroangiopathie.

Keywords

Haematopoietic stem cell transplantation - diffuse alveolar haemorrhage - haemorrhagic cystitis - veno-occlusive disease - transplantassociated microangiopathy

Schlüsselwörter

Stammzelltransplantation - diffuse alveoläre Hämorrhagie - hämorrhagische Zystitis - Venenverschlusskrankheit - transplantationsassoziierte Mikroangiopathie

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