Surviving the cure: long term followup of hematopoietic cell transplant recipients

Abstract

Advances in hematopoietic cell transplantation (HCT) have led to an increasing number of transplant survivors. However, long-term survival is challenged by late relapse, late complications and late non-relapse mortality, and HCT survivors need continued lifelong surveillance for screening, early detection and timely treatment of late complications such as secondary cancers, late infections and organ toxicity. Guidelines for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT were updated and published in 2012. However, several barriers to the care of HCT survivors and routine utilization of these guidelines in clinical practice exist. Examples include paucity of and challenges to conducting prospective randomized trials for screening and prevention of late complications, lack of resources to manage late effects at the level of transplant centers and community health care providers, and inadequate tools to facilitate care and followup of HCT survivors. We summarize the longterm followup guidelines in this review, discuss ways that providers can integrate and utilize them for the care of their patients, and identify areas for research that can inform and increase the utilization of screening and prevention guidelines in clinical practice. Keywords: hematopoietic cell transplantation; long-term survival; late complications; screening; preventive practices INTRODUCTION Several advances in transplantation techniques and supportive care practices over the last four decades have improved long-term survival of patients undergoing autologous or allogeneic hematopoietic cell transplantation (HCT). As patients survive longer, there is an increasing recognition that pre-, peri-and posttransplant exposures have the potential to compromise life expectancy and can contribute to development of late complications. These complications can cause substantial morbidity and mortality and can impair quality of life among HCT survivors. This review will summarize the contemporary literature on long-term survival after autologous and allogeneic HCT and the recently updated guidelines for long-term followup of HCT survivors. Bone Marrow Transplantation

Occupational status among adult survivors following allo-SCT

“…32,33 This may be because allo-SCT survivors often face severe complications and slow recovery. 7,8,12 It should be noticed that reduced work capacity was related to only part-time work at follow-up and not to full-time work here. Cancer survivors have a higher risk of unemployment, 31 being on a disability pension or otherwise being excluded from the labour market compared with the control groups.…”

“…38,39 Severe long-term effects may have a role in the RTW process, and SCT survivors therefore should undergo screening for functional and psychosocial consequences of treatment at their annual comprehensive physical examination. 11,12,40 However, with an increasing number of SCT survivors, the question of how to find resources for long-term follow-up is yet to be addressed. 41 Today, Table 4.…”

“…2 Paid work is essential for an individual's identity and health, enables the person to regain a sense of normality [3][4][5] and is highly desirable from a social and economic perspective. 6 A substantial number of SCT long-term survivors report disease-and treatmentrelated problems that may last for a considerable time, with a possible negative influence on general well-being, quality of life [7][8][9][10][11][12] and participation in paid work. 13 Moreover, being in work is associated with better well being among survivors previously treated with SCT.…”

Mothers' perceptions of care practices for children who underwent heart transplantation

“…In addition to these, there are situations inherent to the environment, including feeding (10) . Therefore, precautions with the cleaning and cooking of food are essential for the prevention of parasitic infections (11) .…”

Provision of long-term monitoring and late effects services following adult allogeneic haematopoietic stem cell transplant: a survey of UK NHS-based programmes

“…In order to ascertain the 224 impediments to LE service delivery, centres rated potential barriers to implementation of an 225 idealised service (suggested both by the survey authors and in the literature). 28 These are 226 summarised in figure 1d, and the three highest rated obstacles all relate to finance/resource 227 provision, with lack of funding for psychological support considered to be the greatest limitation. 228 229 DISCUSSION 230…”