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.

autologous hematopoietic stem cell transplantation, AHSCT, autoimmune diseases, agranulocytosis, neutropenia, febrile neutropenia, intensive care unit, ICU, engraftment syndrome, infections.

Alexander, T. (2025). Autologous haematopoietic stem cell transplantation for autoimmune diseases. Bone Marrow Transplantation. https://doi.org/10.1038/s41409-025-02695-y

Daikeler, T., Tichelli, A., & Passweg, J. (2012). Complications of autologous hematopoietic stem cell transplantation for patients with autoimmune diseases. Pediatric Research, 71(2), 439–444. https://doi.org/10.1038/pr.2011.157

Dubinina, Y. N., et al. (2025). Practice of inflammatory biomarkers for prediction of infectious complications after autologous hematopoietic stem cell transplantation. Oncohematology.

Greco, R., et al. (2021). Hematopoietic stem cell transplantation for autoimmune diseases in the time of COVID-19. EBMT guidelines.

Herrera Rueda, G. A., et al. (2024). Evaluation of adherence, safety and effectiveness of an antibiotic de-escalation strategy in patients with febrile neutropenia during autologous hematopoietic stem cell transplantation. Journal of Bone Marrow Transplantation and Cellular Therapy, 5(2).

Kalincik, T., et al. (2023). AHSCT vs fingolimod, natalizumab, and ocrelizumab in highly active multiple sclerosis. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2023.1542

Levin, D., et al. (2022). Hematopoietic cell transplantation for systemic sclerosis. Cells, 11(23), 3912. https://doi.org/10.3390/cells11233912

Muraro, P. A., et al. (2017). Long-term outcomes after autologous hematopoietic stem cell transplantation for multiple sclerosis. JAMA Neurology, 74(4), 459–469. https://doi.org/10.1001/jamaneurol.2016.5867

Park, S. H., et al. (2006). Current trends of infectious complications following hematopoietic stem cell transplantation. The Korean Journal of Hematology.

Sieiro Santos, C., et al. (2025). Autologous hematopoietic stem cell transplantation in autoimmune diseases. ACR Open Rheumatology. https://doi.org/10.1002/acr2.70131

Stephens, R. S. (2019). ICU complications of hematopoietic stem cell transplant. In Evidence-based critical care. Springer.

Strunz, P. P., et al. (2021). Immunological adverse events after autologous hematopoietic stem cell transplantation in systemic sclerosis. Frontiers in Immunology.

Gazkhanovna, M. A., Makhmatovich, A. K., & Utkirovich, D. U. (2022). Clinical efficacy of extracorporeal and intravascular hemocorrection methods in psoriasis. Academicia: An International Multidisciplinary Research Journal, 12(2), 313-318.

Madasheva, A. G., & Abdiev, K. M. (2023). Blood transfusion therapy in patients with vitamin B12 deficiency anemia after resection of 2/3 of the stomach. Science and Education, 4(5), 407-412.

Мадашева, А. Г., & Жураева, М. З. (2019). Биохимические показатели и комплексное лечение больных псориазом с лечебным плазмаферезом. Достижения науки и образования, (10 (51)), 78-82.

Мадашева, А., Бергер, И., Махмудова, А., Абдиев, К., & Амерова, Д. (2025). Лабораторная диагностика. восточная европа. лабораторная диагностика, 14(1), 87-96.

Мадашева, А. Г. (2022). Клинико-неврологические изменения у больных гемофилией с мышечными патологиями. Science and Education, 3(12), 175-181.

Мадашева, А. Г. (2022). Коррекция диффузной алопеции при железодефицитной анемии. Science and Education, 3(12), 231-236.

Мадашева, А. Г., Дадажанов, У. Д., Абдиев, К. М., Маматкулова, Ф. Х., & Махмудова, А. Д. (2019). Динамика электронейромиографических показателей и эффективность электрической стимуляции мышц у больных гемофилией с мышечными атрофиями. Достижения науки и образования, (10 (51)), 26-30.