Long-term complications and side effects after allogeneic hematopoietic stem cell transplantation: an update

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective therapy for various malignant and non-malignant diseases. Many patients have now been followed for two or three decades posttransplant and are presumed to be cured. With the tremendous advances achieved in terms of supportive care, it is reasonable to expect outcomes to improve steadily and consequently increasing numbers of transplant survivors will be facing life after the initial transplant experience. Although long-term allo-HSCT survivors generally enjoy good health, for many others, cure or control of the underlying disease is not accompanied by full restoration of health. The burden of long-term morbidity borne by allo-HSCT survivors is substantial, and long-term follow-up of patients who received allo-HSCT is now widely recommended. Immediate survival is no longer the sole concern after allo-HSCT. The goals should also include complete recovery of the overall health status with normal physical and psychological functioning. Long-term side effects after allo-HSCT include non-malignant organ or tissue dysfunction, changes in quality of life, infections related to abnormal immune reconstitution and secondary cancers. Many of these can be attributed to the deleterious effects of chronic graft-versus-host disease. The aims of this review are to provide an update on the recent research evidence in the field.

Factores sociodemográficos y clínicos asociados a la recepción de cuidado informal en pacientes con neoplasia hematológica: estudio basado en las diferentes etapas del tratamiento

“…Este cuidado es especialmente más frecuente en la etapa pretrasplante y durante el primer año tras el trasplante, alargándose en el tiempo para quienes han desarrollado complicaciones y efectos secundarios graves o han sufrido una recaí-da en la enfermedad 5,6,29 . Evidenciamos una relación complementaria entre los cuidados informales y formales, bajo el supuesto de que, dada la nula significatición estadística del parámetro asociado al cuidado formal en nuestros modelos, este puede estar presente en determinados casos para mejorar la situación del cuidador y/o del paciente.…”

Kidney Complications Due to Hematopoietic Stem Cell Transplantation-A Disorder of an Increasing Incidence?

“…The intensity of the conditioning regimen, especially the use of full-dose myeloablative total body irradiation (TBI) is more likely to cause late complications after allo-HSCT. On the other hand, it has been well-established that the use of RIC can reduce shortterm acute toxicity, but it has also been well-documented that the probability of chronic graft-host-versus disease (cGHVD) is not reduced after implementation of this regimen, namely because this approach is used in older patients and in more advanced disease stages [1,[6][7][8]. These observations are supported by the study of Al Hazzouri, as well [9]).…”

“…Hematopoietic stem cell transplantation (HSCT) is becoming an increasingly popular treatment considering that it is the only curative option for many malignant and non-malignant diseases [1]. In general, HSCT consists of three steps.…”

“…These are usually methotrexate or the calcineurin inhibitors (CNIs) cyclosporine or tacrolimus. Using the mentioned approach many patients have now been followed for two or three decades post-transplant and are presumed to be cured [1,2]. On the other hand, a great proportion of these patients are experiencing long-term side effects after HSCT, including non-malignant organ or tissue dysfunction, changes in quality of life, infections and secondary malignancy [3].…”

The experience of survival following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia

“…Between 2001-2011, 90,000 allo-HSCTs were performed globally (1), with 4,369 of these performed in Australia (2) . With improvements in donor selection, conditioning therapies and supportive care, more recipients are living longer (3), and up to 85% are expected to be alive at 10 years (4,5).…”