Hematopoietic stem cell transplantation: a primer for the primary care physician

Abstract

Hematopoietic stem cell transplantation has been used for many years to treat various malignant and nonmalignant hematologic conditions. However, the high-dose conditioning regimen can lead to major organ dysfunction, life-threatening infection and bleeding. In the allogeneic setting, graft-versus-host disease may also develop, making post-transplant management complex. Once a transplant recipient is discharged from hospital and returns to his or her local community, the primary care physician can play an important role in care. Recipients of stem cell transplants may be severely immunocompromised for many months after transplantation, especially if they are still taking immunosuppressive drugs. Furthermore, endocrine and metabolic deficiencies can develop, and transplant survivors are at risk of a second malignant disease. This review is intended as a basic overview of allogeneic and autologous stem cell transplantation with a special focus on long-term follow-up issues relevant to primary care providers.

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Fig. 1: Collection of stem cells by direct aspiration from bone marrow, with the donor under general anesthetic.

Fig. 2: Course of events and risks associated with allogeneic transplantation. Blue boxes represent the 4 components of transplantation as outlined in the text; yellow boxes represent the various risks at different stages. RBC = red blood cells.

Fig. 3: Oropharyngeal mucositis, which may occur as a result of conditioning before stem cell transplantation.

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Fig. 4: Rash of graft-versus-host disease.

Fig. 5: Patient receiving infusion of autologous stem cell preparation.

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Fig. 6: Oral lichenoid mucosal reaction and periodontal disease, occurring as part of graft-versus-host disease.