guidebook. - Fanconi Anemia Research Fund

Chapter 10: Unrelated Donor HSCT
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of treatment is methylprednisolone. Other agents successfully
used in the management of acute and chronic
GvHD include antithymocyte globulin (ATG), mycophenolate
mofetil (MMF), thalidomide, and psoralens
with ultraviolet light (PUVA). PUVA is not recommended,
however, as it may be particularly toxic in FA
patients.
Infectious Disease Prophylaxis
Infectious complications after alternate donor HSCT
are a major problem for FA as well as non-FA patients,
but may be a greater risk in FA patients due to: 1) the
unique sensitivity of FA patients to chemoradiotherapy;
2) the resultant breakdown of mucosal barriers after
treatment; 3) the extensive period of neutropenia; and
4) considerable transfusion exposure prior to HSCT and
the resultant exposure to infectious agents.
For these reasons, strategies are needed to prevent
infection in the early period after alternate donor HSCT
and to hasten immune recovery. Prophylactic antibiotic
regimens commonly used after HSCT are outlined in
Table 10.
Table 10: Common Infection Prevention Strategies
Yeast/Fungal Infections
• Fluconazole (systemic yeast)
• Nystatin (oral yeast)
• Vorizonazole (yeast and filamentous fungus)
• Amphotericin-based agents (yeast and filamentous fungus)
Viral Infections
• Acyclovir (herpes simplex)
• Ganciclovir (cytomegalovirus)
Protozoal Infections
• Bactrim/Septra (pneumocystis)