Autoimmune disease can be viewed as an insurrection by security forces charged with protecting us from lurking outside dangers. What ensues is either smoldering conflict to attrition or large-scale open warfare. Treatments have generally been disappointing. Autoimmune phenomena are sometimes consequences of both autologous and allogeneic hematopoietic cell transplantation (HCT). So, why would one consider treating autoimmune diseases with HCT?
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.
Antithymocyte globulin (ATG) has been used in hematopoietic stem cell transplantation (HSCT) for several decades. Its important role in the treatment of aplastic anemia was noted early, and its usefulness has remained through the decades both as part of the conditioning regimen for some HSCT applications and as a therapy for acute graft-versus-host disease (GVHD).
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.
The American Society for Blood and Marrow Transplantation (ASBMT) believes that development of a series of evidence-based reviews will address an important need of both the transplant community and a larger non-transplant audience to codify the current state of knowledge of the role of hematopoietic stem cell transplantation (SCT) in the management of various diseases.
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.