Second solid tumors: screening and management guidelines in long-term survivors after allogeneic stem cell transplantation.
Semin Hematol. 2012 Jan;49(1):4-9
Authors: Socié G, Rizzo JD
Abstract
With greater numbers of patients surviving long-term after allogeneic stem cell transplantation (SCT), second malignancies have increasingly been recognized. Secondary solid tumors, the most prevalent second malignancies after allogeneic SCT, are reviewed with particular emphasis on recent developments in the pathogenesis, early diagnosis, and treatment of these transplant-related complications.
Challenges to Preventing Infectious Complications, Decreasing Re-hospitalizations, and Reducing Cost Burden in Long-Term Survivors After Allogeneic Hematopoietic Stem Cell Transplantation.
Semin Hematol. 2012 Jan;49(1):10-4
Authors: Fuji S, Kapp M, Einsele H
Abstract
Even though the overall outcome after allogeneic transplant has improved significantly in the last decades, late infectious diseases are still the most important causes of late morbidity and mortality. Here, impaired immune reconstitution and therapy of chronic graft-versus-host disease (GVHD) represent the major risk factors. In this review, we give a comprehensive overview of late infectious complications and summarize possible diagnostic and therapeutic interventions to prevent these complications.
Late pulmonary complications after allogeneic hematopoietic stem cell transplantation: diagnosis, monitoring, prevention, and treatment.
Semin Hematol. 2012 Jan;49(1):15-24
Authors: Bacigalupo A, Chien J, Barisione G, Pavletic S
Abstract
Bronchiolitis obliterans syndrome (BOS) is a life-threatening complication that occurs among recipients of allogeneic lung and hematopoietic stem cell transplantation (allo-HSCT). BOS usually occurs within the first 2 years but may develop as late as 5 years after allo-HSCT. Recent prevalence estimates suggest that BOS is likely underdiagnosed in the clinical setting and that 14% of all long-term survivors with chronic graft-versus-host disease (GVHD) may develop BOS. It is difficult to diagnose and once respiratory symptoms appear, most allo-HSCT recipients show severe airflow obstruction. This may be due, at least in part, to the low sensitivity of standard spirometry in detecting small airways obstruction and lack of formal recommendations for screening for this complication. The prognosis of BOS is poor with reported 5-year survival of about 15%. A key obstacle in advancing clinical research in BOS is the lack of diagnostic and therapeutic response standards, making interpretation of survival and treatment results between studies difficult. This situation has significantly improved due to the introduction of the National Institutes of Health (NIH) criteria, which provide investigators with common definitions for studying BOS and for assessing the effects of therapeutic interventions. Future advances in the therapy of BOS may need to include development of better early intervention strategies based on identification of reliable early biological markers of the disease. It would be also important to improve understanding of the biological heterogeneity of this devastating complication after allo-HSCT.
Cardiovascular complications in long-term survivors after allogeneic hematopoietic stem cell transplantation.
Semin Hematol. 2012 Jan;49(1):25-34
Authors: Rovó A, Tichelli A,
Abstract
Cardiovascular diseases (CVD) are emerging late effects after allogeneic hematopoietic stem cell transplantation (allo-HSCT), leading to considerable morbidity and mortality. These late CVD are in most cases related to enhanced atherosclerosis, promoted by the early appearance after transplantation of cardiovascular risk factors. According to the data obtained from the general population it is very likely that early intervention on these cardiovascular risk factors might defer the appearance of late CVD. This review focuses on the published data of cardiovascular diseases after transplantation, the potential associated risk factors, and the postulated pathophysiological mechanisms. A suggested approach for early identification of patients at risk, optimal surveillance, and screening of the modifiable cardiovascular risk factors and the possible early interventions are also discussed here. Long-term survivors should be assessed lifelong after HSCT; all healthcare providers involved in the follow-up of these patients should be aware of premature health threatening of cardiovascular diseases after transplantation.
Management of high ferritin in long-term survivors after hematopoietic stem cell transplantation.
Semin Hematol. 2012 Jan;49(1):35-42
Authors: Brissot E, Savani BN, Mohty M
Abstract
Management of high serum ferritin levels after allogeneic hematopoietic stem cell transplantation (allo-HSCT) should, from the diagnostic standpoint, be based on the pathophysiological mechanisms underlying the development of hyperferritinemia. This knowledge is essential for differentiating increased serum ferritin due to iron overload from “non-iron overload” situations such as inflammation, metabolic syndrome, or hepatitis. Once body iron overload has been proven, especially by quantifying tissue iron excess with the noninvasive magnetic resonance imaging (MRI) method, it is important, considering the damaging effects of chronic iron overload in these patients, to start iron depletive therapy by oral chelation or phlebotomy. At present, more data are needed to assess the long-term deleterious effects of iron excess in the HSCT population, and to define the most appropriate therapeutic strategy for removing iron burden. Also, preventing iron overload prior to HSCT might prove essential for improving patient prognosis through decreasing HSCT-related mortality.
Gastrointestinal, hepatobiliary, pancreatic, and iron-related diseases in long-term survivors of allogeneic hematopoietic cell transplantation.
Semin Hematol. 2012 Jan;49(1):43-58
Authors: Kida A, McDonald GB
Abstract
Gastrointestinal and hepatobiliary problems in the second year after allogeneic hematopoietic cell transplant (HCT) are usually a continuation of symptoms of protracted acute graft-versus-host disease (GVHD), chronic GVHD, medication side effects, and infection related to immune suppression. As time passes, as tolerance develops, and as immunity improves, the frequency and severity of these problems wane, but new problems involving the gut and liver may arise, sometimes insidiously and sometimes decades after the transplant. Examples are esophageal strictures related to chronic GVHD, gallstones, cirrhosis caused by chronic hepatitis C, secondary malignancy, and rare cases of pancreatic atrophy. One very common complication of transplantation, iron overload, is often associated with substantial iron accumulation in the liver; however, the most troublesome complications are not hepatic but cardiac and endocrine-related.
Bone loss and avascular necrosis of bone after hematopoietic cell transplantation.
Semin Hematol. 2012 Jan;49(1):59-65
Authors: McClune B, Majhail NS, Flowers ME
Abstract
Advances in transplantation technology and supportive care measures have resulted in significant decrease in early mortality resulting in continued growth in the number of long-term hematopoietic cell transplantation (HCT) survivors. The intensity of chemotherapy and total body irradiation regimen used pretransplantation to eradicate the primary disease can lead to organ toxicities, including significant bone complications after HCT. Bone loss is frequent in HCT recipients and results from impaired bone mineralization through disturbances of calcium and vitamin D homeostasis, osteoblast and osteoclast dysfunction, and deficiencies in growth or gonadal hormone secretion. Exposure to glucocorticoids and calcineurin inhibitors for prevention and treatment of graft-versus-host disease (GVHD) represents one of the major causes for the increased risk of osteoporosis and avascular necrosis of bone (AVN) in recipients of allogeneic HCT. In this article we review the incidence, pathogenesis, and risk factors for osteoporosis and AVN after allogeneic HCT and discuss general guidelines for their treatment and monitoring based on the limited available reports.
Endocrine complications in long-term survivors after allogeneic stem cell transplant.
Semin Hematol. 2012 Jan;49(1):66-72
Authors: Gunasekaran U, Agarwal N, Jagasia MH, Jagasia SM
Abstract
As survival rates continue to increase after allogeneic stem cell transplant (allo-SCT), the associated long-term complications of transplant need to be taken into consideration. Here, we review the endocrine and metabolic complications associated with transplant survivors, including diabetes, dyslipidemia, hypertension, cardiovascular disease, hypogonadism, vitamin D deficiency, osteoporosis, thyroid disease, adrenal dysfunction, and pituitary disorders, and provide a brief summary of evaluation and treatment of these conditions.
Chronic kidney diseases in long-term survivors after allogeneic hematopoietic stem cell transplantation: monitoring and management guidelines.
Semin Hematol. 2012 Jan;49(1):73-82
Authors: Abboud I, Peraldi MN, Hingorani S
Abstract
Chronic kidney disease (CKD) occurs commonly (prevalence of approximately 20% in a large series) after allogeneic hematopoietic stem cell transplantation (HSCT). There are three distinct clinical entities that occur after HSCT: thrombotic microangiopathy (TMA), nephrotic syndrome (NS), and idiopathic or graft-versus-host disease (GVHD)-related CKD. Acute renal function decline occurs in the majority of patients in the first months after transplantation. This acute kidney injury can persist and is a risk factor for the later development of CKD. However, the potentially independent role of GVHD, chronic inflammation, and chronic exposure to calcineurin inhibitors in the development and progression of CKD warrants further investigation. Careful monitoring of blood pressure, renal function, and proteinuria is mandatory in patients undergoing HSCT, especially older patients with pre-existent renal impairment. Renal function should be evaluated before HSCT and monitoring should occur at least every 6 to 12 months in these patients. Renal biopsies are indicated in patients with proteinuria and persistent or progressive rises in serum creatinine to determine etiology and prevent progression to end-stage renal disease (ESRD).
PMID: 22221787 [PubMed - in process]
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