Late Effects Surveillance Recommendations among Survivors of Childhood Hematopoietic Cell Transplantation: A Children's Oncology Group Report

Abstract

Hematopoietic cell transplantation (HCT) is an important curative treatment for children with high-risk hematologic malignancies and solid tumors, and increasingly, non-malignant diseases. Given improvements in care, there is a growing number of long-term survivors of pediatric HCT. Compared with non-transplanted childhood cancer survivors, HCT survivors have been shown to have a substantially increased burden of serious chronic conditions and impairments involving virtually every organ system and overall quality of life. This likely reflects the joint contributions of pre-transplant treatment exposures and organ dysfunction, the transplant conditioning regimen, and any post-transplant graft versus host disease (GVHD). In response, the Children’s Oncology Group (COG) has created Long-Term Follow-Up Guidelines (www.survivorshipguidelines.org) for survivors of childhood, adolescent, and young adult cancer, including those treated with HCT. Guidelines taskforces, consisting of HCT specialists, other pediatric oncologists, radiation oncologists, organ-specific subspecialists, nurses, social workers, other healthcare professionals, and patient advocates have systematically reviewed the literature with regards to late effects after childhood cancer and HCT since 2002, with the most recent review completed in 2013. For the most recent review cycle, over 800 articles from the medical literature relevant to childhood cancer and HCT survivorship were reviewed, including 586 original research articles. Provided here-in is an organ system-based overview that emphasizes the most relevant COG recommendations (with accompanying evidence grade) for the long-term follow-up care of childhood HCT survivors (regardless of current age) based on a rigorous review of the available evidence. These recommendations cover both autologous and allogeneic HCT survivors, those transplanted for non-malignant diseases, and those with a history of chronic GVHD.

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report

“…194–196 The Children’s Oncology Group (COG) created long-term follow-up guidelines (www.survivorshipguidelines.org) for children, adolescent, and young adults who underwent HCT. 197 Consensus-based recommendations for screening and prevention of solid cancers were adapted from those for the general population through collaboration of the CIBMTR Late Effects and Quality of Life Working Committee and the EBMT Complications and Quality of Life Working Party for children and adults. 198 …”

Morbidity and Mortality Differences Between Hematopoietic Cell Transplantation Survivors and Other Cancer Survivors

“…2 Thus, it becomes important to clarify the patterns of late morbidity and mortality in this population. 3,4 Most studies of late serious health outcomes following HCT have focused on original disease relapse, chronic graft versus host disease (GVHD), and second cancers. The incidence of other serious outcomes among HCT survivors remains less well described, although rates of serious cardiopulmonary disease, long-term infectious complications, and overall rates of serious chronic conditions also are greater than in the general population.…”

Graft-Versus-Host Disease (GvHD)

“…Compared with childhood cancer survivors who did not undergo transplantation, HSCT survivors have a substantially increased burden of serious chronic conditions and impairments involving every organ. A history of GvHD or presence of cGvHD contributes to increase rate of long-term complications in the paediatric transplant survivors (Chow et al 2016). Chronic GvHD has negative effects on an individual's physical and mental health and can lead to the development of functional impairments and activity limitations over their lifetime (Baird et al 2010) as well as reduced quality of life (Inagaki et al 2015).…”