Late Complications of Allogenic Stem Cells Transplantation in Leukaemia

Abstract

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) can cure leukaemia. However, long term complications of post transplantation interfere with the patients' full recovery. The objective of this review was to identify the various long term complications and to assess their individual prevalences. METHODS: Electronic databases including PubMed, Google Scholar and Cochrane were searched for years 2004-2017. The keywords used were leukaemia, allogenic stem cell transplantation, prevalence, side effects, long term, delayed, adverse effects, complications and outcome. RESULTS: A total of ten articles were included for analysis. There were 5 prospective studies, 3 retrospective studies and 2 cross sectional studies. A total of 40,069 patients, (20,189 males and 17,191 females) participated in these 10 studies. The gender of 2689 patients were not disclosed. Most common late complications and prevalence were chronic graft versus host disease (43% at 5 years post HSCT), secondary tumor (21% at 20 years post HSCT), hypothyroidism (11% at 15 years), bronchiolitis obliterans (9.7% at 122 days), cardiovascular disease (7.5% at 15 years) and avascular necrosis (5.4% at 10 years). The prevalence of azoospermia was 71.1% and depression, 18%. For the latter two conditions no time limit was available. Follow up duration ranged from 2 years till 30 years post HSCT. CONCLUSION: While allogenic stem cell transplantation is an effective cure for leukaemia, the procedure is associated with complications that can have their onset many years after the procedure.

Allogeneic stem cell transplantation in the treatment of acute myeloid leukemia: An overview of obstacles and opportunities

“…A recent investigation of over 40000 leukemia patients who were subjected to allo-HSCT revealed that the most frequent late-onset complications of this therapeutic procedure were azoospermia (approximately 71.0%), cGVHD (5-year post-allo-HSCT prevalence at approximately 43.0%), secondary malignancies (20-year post-allo-HSCT prevalence at approximately 21.0%), depression (post-allo-HSCT prevalence at approximately 18.0%), hypothyroidism (15-year post-allo-HSCT prevalence at approximately 11.0%), bronchiolitis obliterans syndrome (4-mo post-allo-HSCT prevalence at approximately 10.0%), cardiovascular disease (15-year post-allo-HSCT prevalence at approximately 7.5%), and avascular necrosis (10-year post-allo-HSCT prevalence at approximately 5.0%)[ 207 ]. However, future prospective studies are needed to clarify the exact epidemiology of late complications of allo-HSCT.…”

How to improve the outcomes of elderly acute myeloid leukemia patients through allogeneic hematopoietic stem cell transplantation

“…Such late complications may affect vital organs like the heart, lungs, liver, and kidneys. Moreover, the incidence of secondary tumors climbed over time, reaching a 20-year CI of 21%, and its risk increased after HSCT, with a 5-year CI of 5% ( 119 , 120 ). Around 10% of patients have cataracts ( 121 ).…”

Ethics of Transplantation

“…This strategy is still in an experimental stage and gives hope that eventually damaged organs can be repaired rather than transplanting the entire organ. However, there are also concerns with such treatment, for instance the risk that the stem cells might not differentiate into the desired tissue or can even lead to excessive differentiation which can lead to tumours (Kanagasundram & Amini, 2018). However, obtaining these adult cells is a relatively easier process than other forms of obtaining stem cells.…”