Non‐endocrine late complications of bone marrow transplantation in childhood: part I

Non-endocrine late complications in children after allogeneic haematopoietic SCT

“…49 Neurological late complications and cognitive/psychosocial consequences Irradiation delivered to the central nervous system and neurotoxic agents is used in conjunction or before HSCT produce permanent neurological and cognitive sequel, especially in very young children. 5,18 In a prospective longitudinal study, Phipps et al 51 found less neurocognitive sequelae in children who underwent HSCT at an older age, but performed below the age of 3 years carried an increased risk of cognitive defects. Front line treatment of the underlying disease with radio-and/or intrathecal chemotherapy given before HSCT may cause progressive damage of the central nervous system and mental deterioration, leading to neuropsychological symptomatology.…”

“…Front line treatment of the underlying disease with radio-and/or intrathecal chemotherapy given before HSCT may cause progressive damage of the central nervous system and mental deterioration, leading to neuropsychological symptomatology. 18,49 Patients affected by predisposing conditions (neurotoxic treatment given in first-line therapy, CSA neurotoxicity, anoxic injury) may develop mesial temporal sclerosis with clinical finding of temporal intractable epilepsy. 52 Leukoencephalopathy, mineralizing microangiopathy, necrotizing leukoencephalopathy and brain atrophy 5,18,53 are diagnosed by magnetic resonance imaging of the brain.…”

“…18,49 Patients affected by predisposing conditions (neurotoxic treatment given in first-line therapy, CSA neurotoxicity, anoxic injury) may develop mesial temporal sclerosis with clinical finding of temporal intractable epilepsy. 52 Leukoencephalopathy, mineralizing microangiopathy, necrotizing leukoencephalopathy and brain atrophy 5,18,53 are diagnosed by magnetic resonance imaging of the brain. Hearing abnormalities and incidence of ototoxicity are increased in patients who are treated with cyclophosphamide, thiotepa, cisplatin and carboplatin either as a part of the chemotherapy or the conditioning regimen before HSCT.…”

“…17 Based on PFT, the LONIPC can be divided into two major groups. 17,18 (a) Obstructive respiratory insufficiency is characterized by reduction in forced expiratory volume in 1 s (FEV1), while forced vital capacity (FVCX80%) remains normal, resulting in decrease of the FEV1/FVC ratio (o70%). 19 This functional constellation is the result of obstruction in the small airways caused by donor T cells' direct immune-mediated damage (that is, cGvHD) or of indirect cGvHD (that is, aspiration secondary to oesophageal cGvHD, abnormal mucociliary transport).…”

Assessing the risk of transplant-related complications and individually tailoring the HSCT procedure in children and adolescents—is it possible?

“…Younger age, history of lung infections, asthma or other lung problems, 32 BU, melphalan (L-PAM), CY and methotrexate may increase pulmonary toxicity. 9 High-dose and single-fraction TBI, is associated with restrictive pulmonary disease. 42 Chronic GVHD is the main risk factor implicated in reducing lung function in children.…”