During a bone marrow transplant there is a major risk of infection
either due to the specific disease or as a result of the required
preconditioning. Severely neutropenic patients benefit from receiving
prophylactic antimicrobial agents within a protected environment and the
thesis opens with a discussion of and a comparison between the different
ways of achieving this protection and an assessment of the contribution
of each component.
n the second part there is description and discussion of the
practical aspects of establishing and managing isolator tents for infants
and children undergoing bone marrow transplantation in the middle of an
open ward in a Children's Hospital built 70 years ago. The isolators were
found to be effective, practical and highly acceptable to almost all
children, their relatives and the attending staff. A pathogen—free food
service complementary to the degree of isolation was established and is
described. Three different regimens of prophylactic antimicrobial agents
were evaluated in the patients undergoing marrow transplantation and
the newer regimen using co—trimoxazole found to be superior in preventing
infection but to have several disadvantages. Extensive surface and
orifice decontamination measures were not found to be worthwhile.
The third section discusses the practical aspects of caring for
infants and children undergoing bone marrow transplantation. The
management and progress of 10 infants with severe combined immune
deficiency, and 10 children with severe aplastic anaemia is described in
detail with particular emphasis on the immune reconstitution of the
survivors. The outcome of eleven children with acute myeloid leukaemia
who underwent allogeneic transplantation is described and compared with
that of children who did not receive a marrow graft. Measures used to
attempt germfree deliveries without caesarian section are described,
evaluated and found wanting.
Viral infections after grafting remain a problem and experience
with cytomegalovirus and papovavirus is discussed. Infections with
herpes simplex and varicella-zoster virus after grafting are discussed
with particular reference to 19 marrow transplant recipients treated with
acycloguanosine which was probably effective though only in the short term.
The thesis concludes with a discussion of the requirement for marrow
grafting facilities in the United Kingdom and finds that six separate
centres, each with five designated beds will be the minimum required
For matched sibling alloqrafts given the present indications and this
service will cost not less than £1.6 million per annum.