Long-term Health Impacts of Hematopoietic Stem Cell Transplantation Inform Recommendations for Follow-up

From Expert Review of Hematology

Smita Bhatia, MD, MPH

08/01/2011

Abstract

Advances in transplantation techniques and supportive care strategies have resulted in a significant improvement in survival of those who have undergone treatment.
However, hematopoietic stem-cell transplantation (HSCT) survivors are at risk of developing long-term complications, such as endocrinopathies, musculoskeletal disorders, cardiopulmonary compromise and subsequent malignancies.
These complications have a direct impact on the morbidity and mortality experienced by HSCT survivors. Two-thirds of HSCT survivors develop at least one chronic health condition; while a fifth develop severe or life-threatening conditions. HSCT patients who have survived for at least 5 years post-transplantation are at a fourfold to ninefold increased risk of late mortality for as long as 30 years from HSCT, producing an estimated 30% lower life expectancy compared with the general population.
The high burden of morbidity experienced by HSCT survivors makes it critically important that there is standardized follow-up of HSCT survivors at high risk for post-HSCT complications.
The Center for International Blood and Marrow Transplant Research/European Group for Blood and Marrow Transplantation/American Society for Blood and Marrow Transplantation and the Children’s Oncology Group long-term follow-up guidelines offer such standardized care. Future steps include wider dissemination and refinement of these guidelines.

Introduction

Hematopoietic stem-cell transplantation (HSCT) is an established curative option for a variety of hematological malignancies.
Advances in transplantation techniques and supportive care strategies have resulted in a significant improvement in survival: 70–80% of those who survive the first 2 years following HSCT are expected to become long-term survivors.
However, cure or control of the underlying disease is not accompanied by full restoration of health.
HSCT survivors are at risk of developing long-term complications, such as endocrinopathies, musculoskeletal disorders, cardiopulmonary compromise and subsequent malignancies (summarized in Table 1 ).
These complications have a direct impact on the morbidity and mortality experienced by HSCT survivors. The high burden of morbidity experienced by HSCT survivors forms the basis for standardized follow-up of HSCT survivors at high risk for post-HSCT complications.
This article summarizes the magnitude of risk of key long-term complications experienced by HSCT survivors, identifying those at increased risk for these complications owing to host characteristics and therapeutic exposures. The article also describes the current recommendations for follow-up, patterns of healthcare utilization by the HSCT survivors and adherence to these recommendations. Finally, the article identifies the need for future research efforts related to HSCT outcomes, identification of those at highest risk and refinement of the existing follow-up guidelines so that those at the highest risk are targeted.

http://www.medscape.org/viewarticle/747181