Chapter 5

Pre-transplant Infectious Disease Evaluation of the Hematopoietic Stem Cell Transplant Candidate

Staci A. Fischer

Routine screening of all recipients	Optional testing (if clinically indicated only)	Comments
CMV EBV antibody HIV antibody, NAT Hepatitis C antibody, NAT Hepatitis B surface antigen and antibody; hepatitis B core antibody HSV-1 and 2 antibody Rapid plasma reagin Varicella zoster virus IgG PPD testing (the role of interferon-release assays for detection of latent tuberculosis in the potential HSCT recipient is currently unclear)	Hepatitis B NAT HTLV-I/II antibodies West Nile virus NAT Toxoplasma IgG antibody Trypanosoma cruzi antibody in donors from endemic areas (e.g. Mexico, Central America, South America) Strongyloides antibody in recipients from endemic areas (e.g., Appalachian USA, Central America, South America, sub-Saharan Africa, South-east Asia, eastern Europe) Coccidioides antibody in recipients from endemic areas (e.g. south-western USA, Mexico, Central America, South America) Histoplasma antibody in recipients from endemic areas (e.g. Ohio and Mississippi river valleys in the USA, other river valleys in North and Central America, eastern and southern Europe, Africa and Australia) Brucella serology in recipients from endemic areas (e.g. Middle East, Mediterranean basin, eastern Europe, Asia, Africa, Central and South America). Ingestion of unpasteurized milk or cheeses from endemic areas is a risk factor for infection	A detailed exposure (travel and residence) history should be obtained, with testing guided as in the ‘Optional testing’ column Resources MMWR 2000; 49(RR10): 1–128 (comprehensive guidelines for prevention of infection in HSCT) www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/TissueSafety – Testing HCT/P Donors for Relevant Communicable Disease Agents and Diseases (updated guidelines for testing blood and HSCT donors for infections including information on specific FDA-approved assays) www.aabb.org/Content/Blood_Donor_History_Questionnaires/HPC-Donor_History_Questionnaire (updated questionnaire for potential blood and HSCT donors, including algorithms for inclusion/exclusion criteria based on results of infection testing) www.advanceweb.com/MLP (ADVANCE for Medical Laboratory Professionals, 2007 – blood donor screening process and infectious disease testing using molecular methods) www.cdc.gov/travel/yellowbook/2010 (Centers for Disease Control and Prevention – updated information on travel-related infections with details on areas of endemicity for the pathogens noted above)

CMV, cytomegalovirus; EBV, Epstein–Barr virus; HIV, human immunodeficiency virus; HSCT, hematopoietic stem cell transplant; HCT/Ps, human cell, tissues and cellular and tissue-based products; HSV, herpes simplex virus; HTLV, human T-cell lymphotrophic virus; IgG, immunoglobulin G; NAT, nucleic acid testing; PPD, purified protein derivative.

Screening of HSCT recipients includes screening for active infection, which could worsen with conditioning regimens, and for latent infections, which could reactivate during therapy administered to combat graft-versus-host disease. The risk of infection is much greater in recipients of allogeneic transplants than in recipients of autologous transplants.