Critical Care Aspects of Stem Cell Transplantation

Bone marrow and blood cell transplants are widely used to treat aplastic anemia, leukemias, lymphomas, myeloma, and immune deficiency disorders. Transplants are also increasingly used to treat other bone marrow disorders such as sickle cell disease and thalassemia. Morbidity and mortality associated with transplants usually result from regimen-related toxicity, such as adverse effects of drugs and radiation given pretransplant, complications of graft versus host disease (GVHD), as well as infections resulting from bone marrow failure. Morbidity and mortality of transplants has steadily decreased over the past four decades because of better supportive care. Recently, there has also been an increased use of reduced intensityconditioning transplants, with less attendant regimen-related toxicity, and an increase in transplants from unrelated donors with increased regimen-related toxicity because of more intensive pretransplant therapy. Pretransplant evaluation of recipients typically includes the following (1–6):