The Burden of Cure: Long-term Side Effects Following Hematopoietic Stem Cell Transplantation (HSCT) in Children

Baker, K. Scott; Bresters, Dorine; Sande, Jane

doi:10.1016/j.pcl.2009.11.008

Cited by 79 publications

(86 citation statements)

References 120 publications

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“…Direct effects of chemotherapy and radiation, as well as indirect effects such as endocrine dysfunction, may contribute to this impairment. 1,28 Growth hormone deficiency was present in 11% of our patients. Although the mean height, weight and BMI z-scores of our patients were close to normal, the range was quite large, and VO 2peak was associated with patient BMI and height z-scores in univariate analyses.…”

Section: Discussionmentioning

confidence: 75%

“…Desaturation (SAT o 90%) occurred in two patients during the test to a minimum SAT of 86% and 88%, respectively. One patient exhibited signs of bronchoconstriction during exercise with a subsequent decline of 26% in FEV 1 .…”

Section: Population Characteristicsmentioning

confidence: 98%

“…Improved survival has increased the focus on late effects and quality of life. 1 HSCT may affect multiple organ systems as a result of the toxicity from chemotherapy, TBI and complications including GvHD and infections. 1 In a recent retrospective study, we documented reduced spirometric values in 34% of paediatric patients more than 18 months from HSCT.…”

Section: Introductionmentioning

confidence: 99%

“…1 HSCT may affect multiple organ systems as a result of the toxicity from chemotherapy, TBI and complications including GvHD and infections. 1 In a recent retrospective study, we documented reduced spirometric values in 34% of paediatric patients more than 18 months from HSCT. 2 However, little is known about the potential consequences of reduced pulmonary function for daily life activities and aerobic exercise capacity.…”

Section: Introductionmentioning

confidence: 99%

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Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Mathiesen

Uhlving

Buchvald

et al. 2014

Bone Marrow Transplant

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Peak oxygen uptake (VO 2peak ), a measure of aerobic exercise capacity, predicts mortality and morbidity in healthy and diseased individuals. Our aim was to determine VO 2peak years after paediatric allogeneic haematopoietic SCT (HSCT) and to identify associations with baseline patient and donor characteristics, transplantation factors, pulmonary function and self-reported sports activity. In this cross-sectional, population-based study, we measured VO 2peak , spirometry and diffusion capacity of the lung (D LCO ) 3-10 years post HSCT. Z-scores were calculated by reference values from healthy subjects. Self-reported hours of sports activity were obtained by interview. We included 63 patients (mean age (range) 14.4 (7-24) years). HSCT patients exhibited lower mean VO 2peak (−1.42 z-score, 95% confidential interval (−1.7; − 1.1)) compared with healthy subjects (Po 0.001). Sixteen patients (25%) had VO 2peak values o − 1.96 z-score. Low VO 2peak was associated with reduced forced expiratory volume in 1 s (R 2 = 0.11, P = 0.009), reduced D LCO /V A (R 2 = 0.09, P = 0.01) and low physical activity (mean VO 2peak z-score inactive group: − 2.1 vs most active group: − 1.1, P = 0.02). No associations between VO 2peak and diagnosis, donor type or GvHD were found. Although causes for reduced VO 2peak may be multiple, our findings stress the need to focus on physical activity post HSCT to prevent lifestyle diseases and improve quality of life. INTRODUCTIONThe population of long-term survivors after allogeneic haematopoietic SCT (HSCT) has increased owing to advances in donor selection and improvements in conditioning regimens and supportive care. Improved survival has increased the focus on late effects and quality of life. 1 HSCT may affect multiple organ systems as a result of the toxicity from chemotherapy, TBI and complications including GvHD and infections. 1 In a recent retrospective study, we documented reduced spirometric values in 34% of paediatric patients more than 18 months from HSCT. 2 However, little is known about the potential consequences of reduced pulmonary function for daily life activities and aerobic exercise capacity.Peak oxygen uptake (VO 2peak ) is a measure of physical capacity, which integrates the responses of the cardiovascular, pulmonary and musculoskeletal systems when faced with physical requirements; 3 thus, VO 2peak allows evaluation of abnormalities, which may not be apparent during rest. 4 As a measure of cardiorespiratory fitness, VO 2peak is a powerful predictor of morbidity and mortality in both healthy and diseased individuals. 5,6 In cancer patients, reduced VO 2peak has been associated with fatigue, which is known to reduce the quality of life, especially in children and young adults for whom physical activities are an essential part of the daily routine. 7 A recent systematic review revealed slightly reduced VO 2peak in survivors of childhood leukaemia compared with healthy controls. 8 Although HSCT has been described as the treatmentvariable most consistently associated with redu...

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Section: Discussionmentioning

confidence: 75%

Section: Population Characteristicsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Mathiesen

Uhlving

Buchvald

et al. 2014

Bone Marrow Transplant

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show abstract

“…A high rate of severe late effects after HSCT, for example, growth-hormone deficiency, hypothyroidism, abnormal pubertal development, osteopenia/ osteoporosis, short stature, dental abnormalities and cataracts, were described in young survivors of pediatric HSCT. 4,28,29 In addition, radiation-induced neuropsychological sequelae should be considered in very young patients. In our studies, cranial irradiation was postponed until the age of 15 months for these anticipated late effects and performed in a minority of patients.…”

Section: Discussionmentioning

confidence: 99%

Favorable outcome in infants with AML after intensive first- and second-line treatment: an AML-BFM study group report

et al. 2011

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Infants o1 year of age have a high prevalence of prognostically unfavorable leukemias and a presumed susceptibility to treatment-related toxicities. A total of 125 infants with acute myeloid leukemia (AML) were treated in studies AML-BFM-98 (n ¼ 59) and -2004 (n ¼ 66). Treatment regimens of both studies were comparable, consisting of intensive induction followed by four courses (mainly high-dose cytarabine and anthracyclines). Allogeneic-hematopoietic stem-cell-transplantation (allo-HSCT) in 1st remission was optional for high-risk (HR) patients. Most infants (120/125 ¼ 96%) were HR patients according to morphological, cytogenetic/molecular genetic and response criteria. Five-year overall survival was 66±4%, and improved from 61±6% in study-98 to 75±6% in study-2004 (P logrank 0.14) and event-free survival rates were 44±6% and 51±6% (P logrank 0.66), respectively. Results in HR infants were similar to those of older HR children (1-o2-or 2-o10-year olds, P logrank 0.90 for survival). Survival rates of HSCT in 1st remission, initial partial response and after relapse were high (13/14, 2/8 and 20/30 patients, respectively). The latter contributes to excellent 5-year survival after relapse (50±8%). Despite more severe infections and pulmonary toxicities in infants, treatment-related death rate was identical to that of older children (3%). Our data indicate that intensive frontline and relapse AML treatment is feasible in infants, toxicities are manageable, and outcome is favorable.

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Hepatic late adverse effects after antineoplastic treatment for childhood cancer

Mulder

Bresters

Hof

et al. 2019

Cochrane Database of Systematic Reviews

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The Burden of Cure: Long-term Side Effects Following Hematopoietic Stem Cell Transplantation (HSCT) in Children

Cited by 79 publications

References 120 publications

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Favorable outcome in infants with AML after intensive first- and second-line treatment: an AML-BFM study group report

Hepatic late adverse effects after antineoplastic treatment for childhood cancer

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