Year: 2015
Type: dissertation
Study design: Observational Study
Abstract: Hematopoietic stem cell transplantation (HSCT) provides effective treatment of hematological malignancies and other disorders. However, the procedure temporarily compromises the immune system resulting in damage to the gastrointestinal (GI) tract, called mucosal barrier injury (MBI), and neutropenia. The GI tract is host to billions of micro-organisms that not only share our body space but are essential for health. These micro-organisms constitute the microbiome and seldom cause us harm. However infection can, and does, occur when the mucosal barrier of the gut is injured. Fortunately antimicrobial agents are employed to prevent and treat infectious complications.\nNever the less, as this thesis shows, almost all HSCT recipients develop fever that is the result of inflammation induced by certain drugs employed to prepare for the transplant. Furthermore, measuring the blood concentrations of the amino acid citrulline provides a means of assessing MBI and indicates that MBI, rather than neutropenia, defines the period of risk of fever and bacteraemia following transplant. With the ready availability of blood, this simple and reliable test can help to explore ways of ameliorating MBI to reduce inflammation and fever which, in turn, would lead to a more tailored approach to antibiotic treatment. This can only be a good thing as it will help reduce the risk of antimicrobial resistance. Knowing the citrulline level could also help decide whether a patient needs to be admitted to hospital or can be treated safely at home.
Author: A H E Herbers
Institution: Radboud University Medical Center
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1123450124