Guidelines for Infection Prophylaxis, Monitoring and Therapy in Cord Blood Transplantation

As an alternative stem cell source, cord blood (CB) has many advantages. However, delayed engraftment, lack of transferred immunity, and a significant incidence of acute graft-versus-host disease renders CB transplant (CBT) recipients at high risk of infectious complications. This guidance written by CBT and infectious disease experts outlines evidence-based recommendations for the prevention and treatment of opportunistic infections in adult patients undergoing CBT. Topics addressed include bacterial, fungal, viral, pneumocystis jirovcii and toxoplasmosis prophylaxis, suggested PCR monitoring for viruses, therapy for the most commonly encountered infections after CBT. We review key concepts including the recent important role of letermovir in the prevention of CMV reactivation. In instances where there is a paucity of data, practice recommendations are provided, including the duration of antimicrobial prophylaxis. (C) 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Automated summary

Cord blood transplant (CBT) has advantages as a stem cell source, but recipients are still at high risk of infectious complications. This guidance provides evidence-based recommendations for preventing and treating opportunistic infections in adult patients undergoing CBT, covering prophylaxis, virus monitoring, infection therapy, and the role of medications like letermovir. Practice recommendations are also given in data-scarce scenarios, including the duration of antimicrobial prophylaxis.