Complications and supportive procedures in transplantation of haemopoietic stem cells

Myeloablative chemotherapy supported by haemopoietic stem cell transplantation remains the standard policy in the treatment of certain haematological malignancies and solid tumors in children. Hematopoietic stem cell transplantation (HSCT) related complications can be classified into early and late effects. Early complications are: mucositis, acute graft versus host disease (GVHD), hemorrhagic cystitis, veno-occlusive disease, transplantation-related lung injury and transplantation related infections. Late complications are chronic GVHD, ocular, endocrine, pulmonary, musculoskeletal, neurocognitive, neuropsychological and immune effects. Infectious complications remain one of the most serious diagnostic and therapeutic problems and are the major cause of morbidity and mortality following stem cell transplantation. Proper preventive strategies for neutropenic patients following myeloablative chemotherapy including prophylaxis and prompt therapy of bacterial, fungal and viral infections correlate with favourable prognosis and survival. Life-threatening complications of circulatory, pulmonary, gastrointestinal, hepatic, and renal function are common and frequently require intensive supportive care. The challenge of improving the results of stem cell transplantation depends, to a large part, on successful preventive measures and good management of complications. Although HSCT is connected with many problems, it represents an important advance in curative treatment for a variety of serious pediatric illnesses. As it is indicated for treatment of an increasing number of diseases, more patients will require intensive supportive therapy.

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