Zusammenfassung
Infektionen stellen einen der wichtigsten prognostischen Faktoren für die Überlebenschancen
von stammzelltransplantierten Patienten, Kinder und Erwachsenen, dar. Das Auftreten
und der Schweregrad der Infektionen sind von der Funktion des Immunsystems im Empfänger
abhängig. Die Funktion wird durch den Einsatz immunsuppressiver Medikamente und die
Geschwindigkeit der Rekonstitution des Immunsystems nach Transplantation bestimmt.
Die Immunrekonstitution kann in die Zeiträume der frühen, mittleren und späten Erholungsphase
eingeteilt werden. Die vorliegende Arbeit stellt die Besonderheiten der Infektionsgefährdung
innerhalb der jeweiligen Zeiträume nach Stammzelltransplantation (SZT) dar. Die grundlegenden
Unterschiede infektiöser Komplikationen sollen zwischen konventionell behandelten
bzw. autologen und allogen stammzelltransplantierten onkologischen Patienten im Kindesalter
aufgezeigt werden. Hierbei soll neben der Gefährdung in der Aplasie, besonders auf
die lang andauernde Immundefizienz nach Transplantation als Risikofaktor für die Entwicklung
schwerer Infektionen hingewiesen werden.
Abstract
Infectious complications are a major cause of morbidity and mortality in pediatric
and adult patients undergoing hematopoietic stem cell transplantion. The incidence
and the severity code of infections depend on the function of the host's immune system.
This function is strongly correlated to the application of immune suppressive therapy
and the speed of immune reconstitution after stem cell transplantation (SCT). The
immune reconstitution can be divided into an early, intermediate and a late phase.
This article describes the risk of infections during the different phases of immune
reconstitution after stem cell transplantation in children. The basic differences
between conventional treated oncologic, autologous and allogenic transplanted children
will be presented. Beside the risk in the phase of aplasia there should be pointed
out that long term immune deficiency is a strong factor for developing a severe infection
after SCT.
Schlüsselwörter
maligne Erkrankungen - Stammzelltransplantation - Infektion - Immunrekonstitution
- Kinder
Key words
cancer - stem cell transplantation - infection - immune reconstitution - children
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Dr. med. Friedhelm R. Schuster
Abteilung pädiatrische Onkologie und Hämatologie · Kinderklinik und Kinderpoliklinik
im Dr. von Haunerschen Kinderspital der Ludwig-Maximilians-Universität München
Lindwurmstr. 4
80337 München
Email: Friedhelm.Schuster@med.uni-muenchen.de
