{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:41:46Z","timestamp":1791916906214,"version":"4.3.4"},"reference-count":106,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>This article systematically reviews the management of key complications in hematopoietic stem cell transplantation (HSCT), including infections, graft-versus-host disease (GVHD), and hepatic sinusoidal obstruction syndrome (VOD\/SOS). It highlights the importance of optimizing conditioning regimens to reduce infection risk and discusses the role of novel antiviral agents like letermovir in transforming infection control. For GVHD, the pathogenesis involving effector and regulatory T-cell imbalances is analyzed, together with prevention strategies such as post-transplant cyclophosphamide with antithymocyte globulin and TCR\u03b1\u03b2\/CD19 depletion. Ruxolitinib is emphasized for steroid-refractory GVHD, and gut microbiota modulation is noted as a promising intervention. For VOD\/SOS, early biomarker detection and defibrotide treatment are critical. The review also explores the impact of immune reconstitution on infection control, GVHD development, and relapse, and examines how emerging approaches, including single-cell sequencing, microbiome analysis, and artificial intelligence, can be applied in building whole-course risk management models. Future directions include developing intelligent platforms and personalized strategies to enhance long-term patient outcomes.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1740067","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T05:37:02Z","timestamp":1773207422000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comprehensive management of hematopoietic stem cell transplantation complications: from infection prevention to immune microenvironment reconstruction"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhengrong","family":"Song","sequence":"first","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinzhi","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziwei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuxu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuejun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shupeng","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2025.05.014","article-title":"Current activity trends and outcomes in hematopoietic cell transplantation and cellular therapy \u2013 A report from the CIBMTR","volume":"31","author":"Spellman","year":"2025","journal-title":"Transplant Cell Ther"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hemonc.2017.05.009","article-title":"Long-term complications after hematopoietic cell transplantation","volume":"10","author":"Majhail","year":"2017","journal-title":"Hematol\/Oncol Stem Cell Ther"},{"key":"B3","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-54310-9_20","article-title":"Unique complications and limitations of haploidentical hematopoietic cell transplant","volume-title":"Haploidentical transplantation: concepts & Clinical application","author":"Einsele","year":"2018"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.761448","article-title":"T cell subsets in graft versus host disease and graft versus tumor","volume":"12","author":"Jiang","year":"2021","journal-title":"Front Immunol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.coi.2025.102685","article-title":"Regulatory T cell approaches for graft-versus-host disease prevention","volume":"98","author":"Bader","year":"2026","journal-title":"Curr Opin Immunol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-019-0705-z","article-title":"Prophylactic, preemptive, and curative treatment for sinusoidal obstruction syndrome\/veno-occlusive disease in adult patients: a position statement from an international expert group","volume":"55","author":"Mohty","year":"2020","journal-title":"Bone Marrow Transplant"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1698763","article-title":"Efficacy and safety of defibrotide for the treatment of hepatic veno-occlusive disease after hematopoietic stem cell transplantation: A systematic review and meta-analysis","volume":"45","author":"Yang","year":"2019","journal-title":"Semin Thromb Hemost"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-025-02524-2","article-title":"The 2023 EBMT report on hematopoietic cell transplantation and cellular therapies. 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