Long‐term follow‐up in hematopoieticstem‐cell transplant patients

Abstract

Hematopoietic stem-cell transplantation (HSCT) has increasingly become an accepted treatment for many childhood diseases and disorders. Potential HSCT recipients can be children with hematological malignancies or solid tumors, as well as congenital and acquired disorders. In the past decade, the use of HSCT in the treatment of pediatric disorders has grown exponentially while advances in supportive care have improved survival rate, contributing to a rapidly growing population of transplant survivors. Although numerous similarities can be found between pediatric and adult long-term HSCT survivors, this article provides a brief overview of the pediatric patients, emphasizing the aspects of surveillance and late effects. Understanding the long-term complications that can occur after HSCT is important in determining the appropriate evaluations and medical treatment for the patient involved. The goal of this article is to assist caregivers in providing optimal care for long-term survivors of HSCT. The initial section of this work comprises the three major causes of late effects in HSCT. It will then encompass a system review of the different potential complications that are seen with HSCT.

Hepato‐biliary late effects in survivors of childhood and adolescent cancer: A report from the Children's Oncology Group

“…[35,36] Chronic GVHD is the leading cause of non-relapse mortality 2 years post HSCT, and approximately 80% of individuals with chronic GVHD have liver involvement. [37] Chronic GVHD manifests as cholestasis with elevated bilirubin and alkaline phosphatase, but may also present as acute hepatitis alone. Immunosuppressive agents, antibiotics, antifungal and antiviral drugs, sedatives, anti-emetics, antipyretics, and parenteral nutrition may exacerbate chronic GVHD associated hepatotoxicity.…”

Acute neurological complications after hematopoietic stem cell transplantation in children

“…However the three patients in our study with severe headache were diagnosed with meningitis. Other complications due to the combination of irradiation and chemotherapy most commonly develop months to years after irradiation (22) and one has to consider that our observation period is limited to 0-3 months. In our study the symptoms in seven patients were diagnosed as encephalopathy.…”

Ocular Complications after Organ and Bone Marrow Transplantation in Children

“…9 The incidence of chronic ocular GVHD after bone marrow and stem cell transplantation ranges as high as 60-90%. 4,10 Ocular infection after renal, cardiac, or bone marrow transplantation is reported between 1.3-5%. 6,[11][12][13] Elevated intraocular pressure is rarely observed, occurring in 1-2% of patients with prolonged oral steroid therapy after transplantation.…”

“…Surveillance of cataracts, ocular GVHD, opportunistic fungal and viral retinal infections, and glaucoma are recommended. 4 The ocular complication rate after transplantation surgery in adults has been well reported. Secondary cataract has been cited in various studies to occur in 25-50% of patients undergoing renal transplantation.…”