Hodgkin lymphoma (HL) is a pathologically and clinically heterogeneous hematologic malignancy. In the United States, an estimated 185,000 people are currently living with this disease, and it accounted for more than 9,000 new cases of cancer in 2015. Chemotherapy and radiation provide long-term benefit to the majority of patients with HL; however, some patients will eventually relapse.
Invasive fungal infections have become the chief infectious threat to allogeneic hematopoietic cell transplant (HCT) recipients. New drugs such as the echinocandins (caspofungin, micafungin, and anidulafungin) and the extended-spectrum azoles (itraconazole, voriconazole, and posaconazole) offer more effective and safer options today. Although these potent antifungal agents make treatment prospects better, there still is considerable risk for death from Candida, Aspergillus, and other mold infections.
With so much success in controlling cytomegalovirus (CMV) disease, one feels almost ungrateful to furtively whisper that there is more yet to do. Still, there is the inconvenience and expense of intravenous regimens, there are toxicity issues with current regimens, and we still face late CMV disease, which is growing in frequency.
The deadly consequences of cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT) are all too well known to those who trained in the 1980s or before. This was a time after transplantation when clinicians and patient alike were beginning to breathe a sigh of relief that the prospects for a successful outcome were bright. Such hopes were quickly dashed by rapid and relentless respiratory failure followed by death.
Once the most feared infectious pathogen threatening patients after hematopoietic cell transplantation, cytomegalovirus (CMV) today is merely a shadow of its former self. We have come a long way in the past two decades. As with suppression of early infection and disease caused by other herpes viruses, forced patience in CMV allows resurgence later in patients whose immunity remains weakened. There is yet work to be done.
Tremendous strides have been made in minimizing the adverse effects of infection after hematopoietic stem cell transplantation (HSCT) over the past several decades. Sequentially, risk factors for various infectious complications have been identified; the nature of deficits in host defenses and their change over time have been characterized; new antimicrobial agents have supplanted older, more toxic, or less efficacious ones; and clinical trials to define the most effective ways to quell morbidity have been conducted.