Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Ann Hematol. 2021 Feb;100(2):321-336. doi: 10.1007/s00277-020-04297-8. Epub 2020 Oct 20.


To ensure the safety of high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT), evidence-based recommendations on infectious complications after HDC/ASCT are given. This guideline not only focuses on patients with haematological malignancies but also addresses the specifics of HDC/ASCT patients with solid tumours or autoimmune disorders. In addition to HBV and HCV, HEV screening is nowadays mandatory prior to ASCT. For patients with HBs antigen and/or anti-HBc antibody positivity, HBV nucleic acid testing is strongly recommended for 6 months after HDC/ASCT or for the duration of a respective maintenance therapy. Prevention of VZV reactivation by vaccination is strongly recommended. Cotrimoxazole for the prevention of Pneumocystis jirovecii is supported. Invasive fungal diseases are less frequent after HDC/ASCT, therefore, primary systemic antifungal prophylaxis is not recommended. Data do not support a benefit of protective room ventilation e.g. HEPA filtration. Thus, AGIHO only supports this technique with marginal strength. Fluoroquinolone prophylaxis is recommended to prevent bacterial infections, although a survival advantage has not been demonstrated.

Keywords: Autologous stem cell transplantation; Infection.

Publication types

  • Review

MeSH terms

  • Germany
  • Hematologic Neoplasms / therapy*
  • Hematology
  • Hematopoietic Stem Cell Transplantation*
  • Hepacivirus / metabolism*
  • Hepatitis B / blood
  • Hepatitis B / prevention & control*
  • Hepatitis B Antibodies / blood
  • Hepatitis B virus / metabolism*
  • Hepatitis C / blood
  • Hepatitis C / prevention & control*
  • Humans
  • Medical Oncology
  • Pneumocystis carinii / metabolism*
  • Pneumonia, Pneumocystis / blood
  • Pneumonia, Pneumocystis / prevention & control*
  • Practice Guidelines as Topic
  • RNA, Viral / blood
  • Societies, Medical
  • Transplantation, Autologous
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use


  • Hepatitis B Antibodies
  • RNA, Viral
  • Trimethoprim, Sulfamethoxazole Drug Combination