The Early Engraftment Period

The early engraftment period begins with the resolution of neutropenia and continues to approximately day 100. The risk of infection in this period is substantially lower in autologous compared with allo-geneic HSCT recipients. With the resolution of neu-tropenia, most patients quickly heal their mucositis. However, GVHD in allogeneic HSCT recipients can lead to recurrent breakdown of mucosal barriers in the gastrointestinal tract, predisposing to recurrent bacterial or fungal bloodstream infections. Nearly all allo-geneic HSCT recipients require indwelling vascular devices through this period, which pose an ongoing risk for bacterial infection. Impaired cell-mediated immunity is the major risk factor for infection in this period, especially in allogeneic HSCT recipients, which may be further compromised by the immuno-suppressive therapy required to prevent rejection or treat GVHD. Additional immune defects in this period include hyposplenism, diminished neutrophil opsonic and phagocytic function, and the deleterious effects of immunomodulating viruses such as CMV and HHV6.

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