National Cancer Institute, National Heart, Lung and Blood Institute/Pediatric Blood and Marrow Transplantation Consortium First International Consensus Conference on late effects after pediatric hematopoietic cell transplantation: the need for pediatric-specific long-term follow-up guidelines

Abstract

Existing standards for screening and management of late effects occurring in children who have undergone hematopoietic cell transplantation (HCT) include recommendations from pediatric cancer networks and consensus guidelines from adult-oriented transplantation societies applicable to all HCT recipients. Although these approaches have significant merit, they are not pediatric HCT-focused, and they do not address post-HCT challenges faced by children with complex nonmalignant disorders. In this article we discuss the strengths and weaknesses of current published recommendations and conclude that pediatric-specific guidelines for post-HCT screening and management would be beneficial to the long-term health of these patients and would promote late effects research in this field. Our panel of late effects experts also provides recommendations for follow-up and therapy of selected post-HCT organ and endocrine complications in pediatric patients.

Figure 1

Late effects after HCT are a result of the interaction between pre-HCT exposures to chemotherapy, radiation, and surgery with the transplant conditioning regimen and acute transplant complications and finally with transplant specific complications such as acute and chronic GVHD, persistent immunodeficiency, etc.. The risk for these outcomes are also modified by other intrinsic and extrinsic factors (age, gender, genetics, social, co-morbidities, lifestyle) that can alter these risks in either a positive or negative manner.