Factors affecting risk of infection following hematopoietic cell transplantation

	High risk	Low risk
Net state of immunosuppression
Underlying disease
Acute myelogenous leukemia/aplastic anemia*	+
Non-first remission malignancy*^¶	+
Chronic myelogenous leukemia, chronic phase		+
Neutropenia^Δ	+
Graft failure	+
CD4 cytopenia <200 cells/microL^¶	+
Glucocorticoids ≥1 mg/kg/day^¶	+
Immunomodulating viruses^¶	+
Age (in years)^◊
>40^Δ	+
<19		+
Graft characteristics
HLA relatedness
Allogeneic matched unrelated	+
Allogeneic mismatched related	+
Allogeneic matched related		+
Autologous		+
T cell depletion
Yes	+
No		+
CD34 infused (autologous) X 10⁶/kg
<2.0	+
>2.5		+
Conditioning regimen, allogenic
Ablative	+
Reduced intensity		+
Organ dysfunction
Severe mucositis^◊	+
Renal failure^◊^Δ	+
Graft failure^◊^Δ	+
Graft-versus-host disease^§, grades II-IV^Δ	+
Skin breakdown, breech in skin due to central venous catheter	+
Liver insufficiency	+
Lung insufficiency	+
Pathogen exposure
Endogeneous: reactivation of latent infection	+
Exogeneous:
Water/food/inanimate objects	+
Healthcare worker	+
Air	+
Donor infection	+

* Most important risk factors pre-engraftment.
¶ Most important risk factors post-engraftment.
Δ Immunomodulating viruses: CMV, HIV, ?HHV-6, ?HHV-7.
◊ Risk is intermediate if age is between 19 and 40 years. Lowest risk is among children.
§ Graft-versus-host disease (especially chronic) and its therapy are major contributors to risk of infection.

Courtesy of Elias J Anaissie, MD.

Graphic 70011 Version 5.0

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Factors affecting risk of infection following hematopoietic cell transplantation