INTENSIVE CARE FOR COMPLICATIONS FOLLOWING AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION DURING THE AGRANULOCYTOSIS PERIOD IN PATIENTS WITH AUTOIMMUNE DISEASES

Abstract

Autologous hematopoietic stem cell transplantation (AHSCT) has become a recognized immunoablative therapy for severe, treatment-refractory autoimmune diseases (ADs), including multiple sclerosis (MS), systemic sclerosis (SSc), and other conditions. The agranulocytosis (profound neutropenia) phase after high-dose conditioning chemotherapy remains the period of highest risk for life-threatening complications, primarily infections and regimen-related toxicities. This expanded narrative review synthesizes current evidence on the incidence, risk factors, diagnosis, and intensive care management of complications during this critical window (typically days 0–14 post-infusion). A comprehensive literature search (PubMed, Scopus, Web of Science, and EBMT guidelines, 2010–2026) identified key data from cohort studies, registries, and expert recommendations. Major complications include febrile neutropenia (>80% incidence), bacterial sepsis (20–40%), invasive fungal infections (5–15% in prolonged neutropenia), engraftment syndrome (10–41% in SSc cohorts), diffuse alveolar hemorrhage, acute kidney injury (up to 30%), and severe mucositis. ICU admission occurs in 8–15% of cases, with leading indications being respiratory failure and septic shock. Modern supportive strategies—rapid empiric antimicrobials, granulocyte colony-stimulating factor (G-CSF), hemodynamic monitoring, organ support, and multidisciplinary care—have reduced treatment-related mortality during this phase to <2% in experienced centers (compared with historical rates >5–10%). Optimized intensive care protocols, early recognition of complications, and adherence to EBMT recommendations are essential to further improve safety and support broader application of AHSCT in carefully selected AD patients.