Chronic graft-versus-host disease and late effects after hematopoietic stem cell transplantation

Abstract

Late effects following HSCT are related to either the transplant process or to the transplant preparative regimen. Problems related to the transplant process include delayed recovery of the immune system and chronic GVHD. Chronic GVHD presents between 3-14 months post-HSCT in approximately 20% of matched sibling transplants and 40% of matched unrelated donor recipients. Most commonly involved sites are skin, mouth, liver, gastrointestinal tract, and eye. Patients with platelet count < 100,000/ml and receiving cortocosteroid therapy at day 80 with any clinical manifestations of chronic GVHD require prolonged immune suppressive therapy with prednisone, cyclosporine +/- other agents. Treatment should be administered until all clinical and pathological signs and symptoms of chronic GVHD have resolved which may take one to several years. Problems related to the transplant preparative regimen include those involving the endocrine system, eyes, lungs, bone, and development of secondary malignancies. Endocrine deficiencies include growth failure with growth hormone (GH) deficiency, overt hypothyroidism, primary gonadal failure, Type 1 or Type 2 diabetes, and exocrine pancreatic insufficiency. These problems develop at any time post-HSCT, but usually occur within the first few years and should be treated with appropriate hormone supplementation. Eye problems are primarily related to development of cateracts secondary to total body irradiation (TBI) or prolonged corticosteroid use. Cateracts developing after fractionated frequently do not require removal. Pulmonary problems may be due to bronchiolitis obliterans (BO) or to restrictive lung disease. BO may be associated with chronic GVHD and may respond to chronic GVHD therapy. Restrictive lung disease does not occur for many years after HSCT. There is not therapy for this problem. Development of decreased bone mineral density (BMD) is related to GH deficiency and/or corticosteroid therapy. Treatment includes withdrawal of corticosteroids, administration of GH and calcium, Vitamin D and antiresorptive agents. All malignant disease survivors are at risk for development of secondary malignancies, including survivors of HSCT. Recipients of TBI are at highest risk as are children. All pediatric and adult survivors of HSCT should be followed for their life-time for development of delayed effects of transplantation.

Adverse psychological outcomes in long-term survivors of hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study (BMTSS)

“…[1][2][3] However, recovery after transplantation is prolonged, often because of complications such as chronic GVHD, cardiopulmonary compromise, endocrinopathies, musculoskeletal disorders, and subsequent malignancies. [4][5][6][7][8][9][10][11][12][13][14][15][16] Recently, we have demonstrated that the cumulative incidence of severe or life-threatening chronic health conditions approaching 35% at 10 years after HCT. 17 These complications contribute significantly to the late morbidity and mortality experienced by HCT survivors, 2,3,17 with a potential impact on their psychological health.…”

Ophthalmological Manifestations in Acute Lymphoblastic Leukemia

“…In the acute phase, there are four stages of severity: hyperemia, chemosis, pseudomembranous conjunctivitis with complete loss of conjunctival epithelium and finally, compromise of the www.intechopen.com corneal epithelium. (Jabs et al, 1989;Sanders, 2002;Uchino et al, 2006) Its presence is related to vital prognosis with a mortality rate of 90% for stages 2 through 4 (Coskuncan 1994, Ohkoshi 1992. Fig.…”

Nutritional support in patients with GVHD of the digestive tract: state of the art

“…Supplementation of the active metabolites 1.25(OH) 2 D 3 or 25(OH) 3 could result in a superior effect on bone density and contribute to modulation of GVHD. 54,55 Vitamin B 12 . Regarding water-soluble vitamins, only vitamin B 12 has been discussed in the literature.…”