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Review
. 2011 Aug;4(4):437-52; quiz 453-4.
doi: 10.1586/ehm.11.39.

Long-term health impacts of hematopoietic stem cell transplantation inform recommendations for follow-up

Smita Bhatia  1
Affiliations
Review

Long-term health impacts of hematopoietic stem cell transplantation inform recommendations for follow-up

Smita Bhatia. Expert Rev Hematol. 2011 Aug.

Abstract

Advances in transplantation techniques and supportive care strategies have resulted in a significant improvement in survival of those who have undergone treatment. However, hematopoietic stem cell transplantation (HSCT) survivors are at risk of developing long-term complications, such as endocrinopathies, musculoskeletal disorders, cardiopulmonary compromise and subsequent malignancies. These complications have a direct impact on the morbidity and mortality experienced by HSCT survivors. Two-thirds of HSCT survivors develop at least one chronic health condition; while a fifth develop severe or life-threatening conditions. HSCT patients who have survived for at least 5 years post-transplantation are at a fourfold to ninefold increased risk of late mortality for as long as 30 years from HSCT, producing an estimated 30% lower life expectancy compared with the general population. The high burden of morbidity experienced by HSCT survivors makes it critically important that there is standardized follow-up of HSCT survivors at high risk for post-HSCT complications. The Center for International Blood and Marrow Transplant Research/European Group for Blood and Marrow Transplantation/American Society for Blood and Marrow Transplantation and the Children's Oncology Group long-term follow-up guidelines offer such standardized care. Future steps include wider dissemination and refinement of these guidelines.

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Figures

Figure 1
Figure 1. Cumulative incidence of avascular necrosis by type of hematopoietic stem cell transplantation
HSCT: Hematopoietic stem cell transplantation. Adapted with permission from [70].
Figure 2
Figure 2. Cumulative incidence of chronic kidney disease by age at exposure to calcineurin inhibitors among allogeneic hematopoietic stem cell transplantation recipients
HSCT: Hematopoietic stem cell transplantation. Adapted with permission from [7].
Figure 3
Figure 3. Cumulative incidence of subsequent malignant neoplasms after hematopoietic stem cell transplantation
(A) Solid tumors. (B) Therapy-related myelodysplasia/acute myeloid leukemia. BMT: Bone marrow transplantation. (A) Adapted with permission from [99]. (B) Adapted with permission from [88].
Figure 4
Figure 4. Cumulative incidence of any chronic health conditions (grades 1–5) and severe or life-threatening chronic health conditions (grade 3 or 4) or death due to a chronic health condition (grade 5) after hematopoietic stem cell transplantation
HSCT: Hematopoietic stem cell transplantation. Adapted with permission from [104].
Figure 5
Figure 5. Late mortality experience of patients undergoing hematopoietic stem cell transplantation
(A) Late mortality after autologous HSCT. (B) Late mortality after allogeneic HSCT. cGVHD: Chronic graft-versus-host disease; HSCT: Hematopoietic stem cell transplantation; SMN: Subsequent malignant neoplasm; SMR: Standardized mortality ratio. (A) Adapted with permission from [2]. (B) Adapted with permission from [1].
See this image and copyright information in PMC

References

    1. Bhatia S, Francisco L, Carter A, et al. Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study. Blood. 2007;110(10):3784–3792. - PMC - PubMed

    1. Bhatia S, Robison LL, Francisco L, et al. Late mortality in survivors of autologous hematopoietic-cell transplantation: report from the Bone Marrow Transplant Survivor Study. Blood. 2005;105(11):4215–4222.. • Utilizes a comprehensive approach (National Death Index, medical records) to describe late mortality and functional status among survivors of 2 or more years after autologous hematopoietic stem cell transplantation (HSCT).

    1. Socie G, Stone JV, Wingard JR, et al. Long-term survival and late deaths after allogeneic bone marrow transplantation. Late Effects Working Committee of the International Bone Marrow Transplant Registry. N. Engl. J. Med. 1999;341(1):14–21. - PubMed

    1. Armenian SH, Sun CL, Francisco L, et al. Late congestive heart failure after hematopoietic cell transplantation. J. Clin. Oncol. 2008;26(34):5537–5543.. • Examines the independent and simultaneous impact of pre-HSCT therapeutic exposures, HSCT conditioning, and post-HSCT comorbidities in the development of post-HSCT congestive heart failure.

    1. Baker KS, Ness KK, Steinberger J, et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood. 2007;109(4):1765–1772.. • Describes the risk of diabetes and hypertension after HSCT, as well as the role of total body irradiation in the development of these complications.

Websites

    1. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. www.survivorshipguidelines.org.
    1. Agency for Healthcare Research and Quality prevention and care management. www.ahrq.gov/clinic/prevenix.htm. - PubMed

MeSH terms