examination in women
1, recommended for all HSCT recipients; 2, recommended for patients with ongoing GVHD or immunosuppression; +, recommended for abnormal testing in a previous time period or for new signs/symptoms.
* including inquiry about school/work attendance, need for social support/disability pension, financial toxicity.
References
1 1. Institute of Medicine, National Research Council. From Cancer Patient to Cancer Survivor: Lost in Transition: An American Society of Clinical Oncology and Institute of Medicine Symposium. Washington, DC: The National Academies Press, 2006.
2 2. Denzen EM, Preussler JM, Murphy EA, et al. Tailoring a survivorship care plan: patient and provider preferences for recipients of hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2019; 25(3):562–569.
3 3. Majhail NS, Murphy E, Laud P, et al. Randomized controlled trial of individualized treatment summary and survivorship care plans for hematopoietic cell transplantation survivors. Haematologica. 2019; 104(5):1084–1092.
4 4. Majhail NS, Rizzo JD, Lee SJ, et al. Recommended screening and preventive practices for long‐term survivors after hematopoietic cell transplantation. Bone Marrow Transplant. 2012; 47(3):337–341.
5 5. Children’s Oncology Group Nursing Discipline, Clinical Practice Subcommittee/Survivorship, Late Effects Committee (2007). Establishing and Enhancing Services for Childhood Cancer Survivors: Long‐Term Follow‐Up Program Resource Guide. Available from: http://www.survivorshipguidelines.org/pdf/LTFUResourceGuide.pdf (accessed 7 September 2020).
6 6. Majhail N, Hashmi S. Long‐term follow‐up program. In: Gluckman E, Niederwieser D, Aljurf M (eds). Establishing a Hematopoietic Stem Cell Transplantation Unit. Cham: Springer, 2018; pp.231–243.
7 7. Rizzo JD, Wingard JR, Tichelli A, et al. Recommended screening and preventive practices for long‐term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, Center for International Blood and Marrow Transplant Research, and the American Society for Blood and Marrow Transplantation (EBMT/CIBMTR/ASBMT). Bone Marrow Transplant. 2006; 37(3):249–261.
CHAPTER 6 Late effects post‐allogeneic hematopoietic stem cell transplantation
Shahrukh K. Hashmi1 and Yoshihiro Inamoto2
1 Division of Blood and Marrow Transplantation, William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA
2 Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
Introduction
Advances in allogeneic hematopoietic cell transplantation (HCT) have increased the curative potential of the procedure and HCT survivors are living longer, however, at a cost of a higher burden of late complications (also known as “late effects”). The late effects have traditionally been defined as the complications arising at least six months after [1], and include both relapse and non‐relapse complications. Though the relapse incidence is highest early after HCT, most recipients remain at risk for relapse beyond one year following HCT [2] and support the use of an intense monitoring program for high‐risk patients with disease‐specific morphologic, radiologic, and/or molecular parameters. Since patients with relapsed disease are treated with intensive therapies, they are conventionally excluded from the general management model of a typical long‐term follow‐up, as discussed in detail elsewhere in this book. The basic concepts of non‐relapse late effects, including the role of chronic graft‐versus‐host disease (cGVHD) in late effects, are discussed in this chapter. The details of management for individual late effects are described later in the book. Details of cGVHD and its management are also described elsewhere.
Most of the late effects can be categorized based on the organ or system‐specific complications and usually arise due to a complex interaction of various factors which may include:
1 Chemotherapy/radiotherapy‐ or immunosuppressive therapy (IST)‐related complications (e.g., increased risk of subsequent cancers or increased risk of diabetes)
2 Direct effect of cGVHD (e.g., dry eye or dry mouth resulting from cGVHD)
3 Pretransplant co‐morbidities (e.g., a high HCT‐CI score)
4 Genetic predisposition to enhanced toxicities. (e.g., the presence of certain polymorphisms can predict late cardiotoxicity).
The complications arising from either of these variables may coalesce to decrease both the survival and the quality of life (QoL), (see Figure