Delivering care to long-term adult survivors of hematopoietic cell transplantation

Abstract

This review highlights long-term and late consequences of hematopoietic cell transplantation (HCT) as well as strategies to manage or prevent complications that are more prevalent after HCT than most other cancer treatments. Chronic graft-versus-host disease stands out as a unique late effect of allogeneic HCT that is not seen after other types of cancer treatment. However, many other complications seen after solid tumor treatments are also common after HCT, including infections, second cancers, bone loss, and cardiovascular, pulmonary, renal, and endocrine dysfunction. Symptoms and syndromes that are reported after HCT include sexual dysfunction, cognitive problems, fatigue, insomnia, musculoskeletal symptoms, emotional distress, anger, and depression. Addressing these complex potential or actual complications requires diligent routine health care to intervene early or, when possible, to prevent late complications. To accomplish early detection and prevention of life-threatening complications, HCT survivors should undergo an annual comprehensive physical examination that includes screening for functional and psychosocial consequences of treatment and encouraging healthy lifestyle behaviors. Clinicians can link survivors to numerous online, print, and video resources to help them advocate for their health needs.

Fig 1.

Subsequent causes of death for adult (A) allogeneic and (B) autologous transplant recipients who survived without recurrent malignancy at least 5 years after transplantation. There were 219 subsequent deaths among 1,625 allogeneic patients and 65 subsequent deaths among 342 autologous patients. All patients were treated at Fred Hutchinson Cancer Research Center from 1970 through 2002. GVHD, graft-versus-host disease.

Fig 2.

Overall quality and quantity of sexual function over 5 years from before to after hematopoietic cell transplantation, with case-matched controls at 5 years and including non–relapse-free survivors (non-RFS) before transplantation. Data adapted.