Long‐term Follow‐up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics

Abstract

Annually, ~50,000 patients undergo hematopoietic stem cell transplantation (HCT) worldwide with almost 22,000 of these patients receiving HCT in the United States. HCT is a curative option for a wide range of hematologic malignancies, and advances in transplantation medicine have resulted in an increase in HCT survivors. It is anticipated that the number of HCT survivors will more than double from 242,000 in 2020 to ~500,000 in 2030. Survivors of HCT are at an increased risk of developing late complications due to exposure to chemotherapy and/or radiation in the pre‐, peri‐, and post‐HCT phases and these cumulative exposures have the potential to damage normal tissue. This tissue damage leads to the early onset of chronic health conditions resulting in premature mortality in HCT survivors, who have a 15‐year cumulative incidence of severe or life‐threatening chronic health conditions exceeding 40%. Due to the significant burden of morbidity in HCT survivors and the delay in the development of long‐term complications, this delicate patient population requires life‐long monitoring due to the risk for neuropsychological, cardiac, pulmonary, renal, hepatic, ocular, skeletal, cardiac, endocrine, fertility, and sexual health complications, as well as secondary neoplasms. This review will focus on recent advances in screening, monitoring, and therapeutics for late‐occurring or long‐term complications in HCT survivors.

A prospective study of the relationship between illness perception, depression, anxiety, and quality of life in hematopoietic stem cell transplant patients

“…33,34 Additionally, addressing depression and anxiety prior to and during recovery from HSCT could positively impact patient ability to engage in their recovery, adhere fully to treatment recommendations, and better cope with the inevitable uncertainty and multitude of potential neuropsychological and physical complications. 35 Our findings also suggest that patients would benefit from additional efforts to assess and when appropriate enhance illness perception prior to HSCT. Some patients may have inaccurate negative perceptions about their illness and/or HSCT.…”

“…While HRQOL following HSCT is clearly an important outcome on its own, studies have also found psychological factors including depression and anxiety associated with higher posttransplant hospital readmission, 31 morbidity, 32 and mortality 33,34 . Additionally, addressing depression and anxiety prior to and during recovery from HSCT could positively impact patient ability to engage in their recovery, adhere fully to treatment recommendations, and better cope with the inevitable uncertainty and multitude of potential neuropsychological and physical complications 35 …”

Evolution and Innovation in Hematopoietic Cell Transplantation and Cellular Immunotherapy: Critical Updates in Therapeutics

“…Post-HCT complications are not limited to infection and GVHD. Saunders and colleagues 11 provide a comprehensive review of long-term effects observed in both autologous and allogeneic HCT patients. The authors provide an indepth evaluation of chronic health conditions observed after HCT, including current guideline recommended approaches for screening, diagnosis, and therapy.…”

Esophagectomy postallogenic hematopoietic stem cell transplantation for hematologic malignancy: A case series

“…Survival rates following allogenic hematopoietic stem cell transplantation (AHSCT) for hematologic malignancies continue to improve. 1 Patients undergo aggressive chemotherapy with or without radiation therapy, followed by relapse of their primary disease, leading to AHSCT. Preparation for transplantation requires intensive preconditioning with immune suppression and chemotherapy, followed by long-term immune suppression to modulate complications such as graft versus host disease (GvHD), an independent risk factor for solid-organ malignancy.…”

“…Preparation for transplantation requires intensive preconditioning with immune suppression and chemotherapy, followed by long-term immune suppression to modulate complications such as graft versus host disease (GvHD), an independent risk factor for solid-organ malignancy. 1 These patients form a difficult cohort for esophagectomy due to their previous chemotherapy or radiation therapy in addition to necessary ongoing immune modulation. This series reports 3 consecutive patients, all with AHSCT and significant GvHD, developing interval esophageal squamous cell carcinoma (SCC) at varying remote intervals from their primary diagnosis and undergoing minimally invasive esophagectomy (MIE).…”