Infection is a common complication of chronic graft versus host disease (cGVHD), and it contributes significantly to the mortality of this condition. As an example, in a prospective cohort study of 159 patients with cGVHD from the University of Minnesota, 42 of the 67 deaths were attributed to infection. Studies from other institutions provide similar data. Accordingly, most authorities emphasize the need for appropriate infection prophylaxis and management. The Guidelines for Supportive Care in cGVHD provide specific recommendations for prophylaxis, and emphasize the lack of direct evidence to support many of them. This chapter will present a review of the infectious syndromes commonly found in cGVHD and will offer recommendations regarding prevention of the different pathogens.
GENERAL CONCEPTS ABOUT INFECTION IN CGVHD
Infection was identified as an important problem in cGVHD since the original descriptions of the disease [5–9]. Six patients described by Graze and Gale in 1979 experienced six episodes of bacteremia/septicemia, six pneumonias (three viral, two bacterial, one Aspergillus), four episodes of zoster and a variety of other infections. Shulman et al., in their description of the “cGVHD syndrome” in 20 patients out of the 227 transplanted at the Fred Hutchinson Cancer Research Center (FHCRC) between 1969 and 1976 reported seven deaths caused by infection. Early on, these investigators had identified cGVHD as the main risk factor for non-Varicella zoster virus (VZV) infection late after transplantation.