The Late Effects in Patients Treated with Allogeneic Hematopoietic Stem Cell Transplantation
Authors:
Ľ. Roziaková 1,2; E. Bojtárová 2; M. Mistrík 2; B. Mladosievičová 1
Authors‘ workplace:
Ústav patologickej fyziológie, LF UK Bratislava, Slovenská republika
1; Klinika hematológie a transfuziológie, LF UK, SZU a UN Bratislava, Slovenská republika
2
Published in:
Klin Onkol 2011; 24(6): 453-459
Category:
Original Articles
Overview
Backgrounds:
Allogeneic hematopoietic stem cell transplantation (HSCT) has become a curative treatment option for a variety of malignant and non-malignant hematological disorders. The number of long-term survivors after HSCT is continuously increasing and quality of their life represents a multidisciplinary concern. The aim of this study was to evaluate the prevalence of the late effects in long-term allogeneic HSCT survivors.
Patients and Methods:
The study included 45 patients aged 12–63 years who survived at least two years after allogeneic HSCT for a hematological disorder. Twelve (26.7%) patients received an irradiation-based conditioning regimen. Median follow-up was 6 years (range 2–18 years).
Results:
Toxicity varied from subclinical to life-threatening. The prevalence of at least one late toxic effect was 88.9%. Endocrine and metabolic complications included thyroid abnormalities in 12 (26.7%) patients, bone and joints complications in 13 (28.8%) and metabolic syndrome in 13 (28.8%). Ocular complications were diagnosed in 20 (44.4%), cardiovascular abnormalities in 15 (33.3%), pulmonary dysfunction in 6 (13.3%) and secondary malignancies in 3 (6.67%) survivors. The number of complications per patient increased with time from HSCT. Chronic graft-versus-host disease was the most significant risk factor associated with ocular, pulmonary and osteoarticular complications.
Conclusion:
Late toxicity of allogeneic HSCT in patients surviving for more than 2 years after this procedure may facilitate conduct of longer follow-up studies and an implementation of interventions to prevent late effects among survivors of serious hematological diseases
Key words:
adverse effects – hematopoietic stem cell transplantation – long-term follow up studies
This study was partly funded by the grats of MZ SR 2007/42-UK-18.
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
Submitted:
24. 3. 2011
Accepted:
26. 9. 2011
Sources
1. Gratwohl A, Baldomero H, Aljurf M et al. Hematopoietic stem cell transplantation: a global perspective. JAMA 2010; 303(16): 1617–1624.
2. Savani BN, Griffith ML, Jagasia S et al. How I treat late effects in adults after allogeneic stem cell transplantation. Blood 2011; 117(11): 3002–3009.
3. Mladosievičová B, Kaiserová E, Foltinová A et al. Dlhodobé nežiaduce účinky terapie u pacientov vyliečených z detskej malignity. Klin Onkol 2007; 20(1): 18–22.
4. Rovó A, Daikeler T, Halter J et al. Late altered organ function in very long-term survivors after allogeneic hematopoietic stem cell transplantation: a paired comparison with their HLA-identical sibling donor. Haematologica 2011; 96(1): 150–155.
5. Baker KS, Ness KK, Weisdorf D et al. Late effects in survivors of acute leukemia treated with hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study. Leukemia 2010; 24(12): 2039–2047.
6. Roziaková Ľ, Mladosievičová B. Endocrine late effects after hematopoietic stem cell transplantation. Oncol Res 2010; 18(11–12): 607–615.
7. Jung MH, Cho KS, Lee JW et al. Endocrine complications after hematopoietic stem cell transplantation during childhood and adolescence. J Korean Med Sci 2009; 24(6): 1071–1077.
8. Tabbara KF, Al-Ghamdi A, Al-Mohareb F et al. Ocular findings after allogeneic hematopoietic stem cell transplantation. Ophthalmology 2009; 116(9): 1624–1629.
9. Gower WA, Collaco JM, Mogayzel PJ Jr. Lung function and late pulmonary complications among survivors of hematopoietic stem cell transplantation during childhood. Paediatr Respir Rev 2010; 11(2): 115–122.
10. Petropoulou AD, Porcher R, Herr AL et al. Prospective assessment of bone turnover and clinical bone diseases after allogeneic hematopoietic stem-cell transplantation. Transplantation 2010; 89(11): 1354–1361.
11. Kodama M, Komura H, Shimizu S et al. Efficacy of hormone therapy for osteoporosis in adolescent girls after hematopoietic stem cell transplantation: a longitudinal study. Fertil Steril 2011; 95(2): 731–735.
12. Saiz A, Graus F. Neurologic complications of hematopoietic cell transplantation. Semin Neurol 2010; 30(3): 287–295.
13. Baker KS, Armenian S, Bhatia S. Long-term consequences of hematopoietic stem cell transplantation: current state of the science. Biol Blood Marrow Transplant 2010; 16(1 Suppl): S90–S96.
14. Tichelli A, Passweg J, Wójcik D et al. Late cardiovascular events after allogeneic hematopoietic stem cell transplantation: a retrospective multicenter study of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation. Haematologica 2008; 93(8): 1203–1210.
15. Rizzo JD, Curtis RE, Socié G et al. Solid cancers after allogeneic hematopoietic cell transplantation. Blood 2009; 113(5): 1175–1183.
16. Majhail NS, Brazauskas R, Rizzo JD et al. Secondary solid cancers after allogeneic hematopoietic cell transplantation using busulfan-cyclophosphamide conditioning. Blood 2011; 117(1): 316–322.
17. Faraci M, Békássy AN, De Fazio V et al. EBMT Paediatric and Late Effects Working Parties. Non-endocrine late complications in children after allogeneic haematopoietic SCT. Bone Marrow Transplant 2008; 41 (Suppl 2): S49–S57.
18. Gratwohl A, Stern M, Brand R et al. Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Cancer 2009; 115(20): 4715–4726.
19. Sun CL, Francisco L, Kawashima T et al. Prevalence and predictors of chronic health conditions after hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study. Blood 2010; 116(17): 3129–3139.
20. Ferry C, Gemayel G, Rocha V et al. Long-term outcomes after allogeneic stem cell transplantation for children with hematological malignancies. Bone Marrow Transplant 2007; 40(3): 219–224.
21. Bailey HK, Kappy MS, Giller RH et al. Time-course and risk factors of hypothyroidism following allogeneic hematopoietic stem cell transplantation (HSCT) in children conditioned with fractionated total body irradiation. Pediatr Blood Cancer 2008; 51(3): 405–409.
22. Abou-Mourad YR, Lau BC, Barnett MJ et al. Long-term outcome after allo-SCT: close follow-up on a large cohort treated with myeloablative regimens. Bone Marrow Transplant 2010; 45(2): 295–302.
23. Niedzielska E, Wójcik D, Barg E et al. Evaluation of selected endocrine complications in patients treated with auto- and allo-haematopoietic stem cell transplantation. Med Wieku Rozwoj 2008; 12(3): 761–766.
24. Fahnehjelm KT, Törnquist AL, Olsson M et al. Visual outcome and cataract development after allogeneic stem-cell transplantation in children. Acta Ophthalmol Scand 2007; 85(7): 724–733.
25. Annaloro C, Usardi P, Airaghi L et al. Prevalence of metabolic syndrome in long-term survivors of hematopoietic stem cell transplantation. Bone Marrow Transplant 2008; 41(9): 797–804.
26. Majhail NS, Flowers ME, Ness KK et al. High prevalence of metabolic syndrome after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2009; 43(1): 49–54.
27. Tichelli A, Bucher C, Rovó A et al. Premature cardiovascular disease after allogeneic hematopoietic stem-cell transplantation. Blood 2007; 110(9): 3463–3471.
28. Carpenter PA. Late effects of chronic graft-versus-host disease. Best Pract Res Clin Haematol 2008; 21(2): 309–331.
29. Fraser CJ, Bhatia S, Ness K et al. Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from the Bone Marrow Transplant Survivor Study. Blood 2006; 108(8): 2867–2873.
30. Tichelli A, Rovó A, Gratwohl A. Late pulmonary, cardiovascular, and renal complications after hematopoietic stem cell transplantation and recommended screening practices. Hematology Am Soc Hematol Educ Program 2008: 125–33.
31. Patriarca F, Poletti V, Costabel U et al. Clinical presentation, outcome and risk factors of late-onset non-infectious pulmonary complications after allogeneic stem cell transplantation. Curr Stem Cell Res Ther 2009; 4(2): 161–167.
32. Jabbour E, Thomas D, Cortes J et al. Central nervous system prophylaxis in adults with acute lymphoblastic leukemia: current and emerging therapies. Cancer 2010; 116(10): 2290–2300.
Labels
Paediatric clinical oncology Surgery Clinical oncologyArticle was published in
Clinical Oncology
2011 Issue 6
Most read in this issue
- Castleman Disease
- Trabectedin Registry
- Long Term Follow up of Eosinophilic Granuloma of the Rib
- Predictive Values of the Ultrasound Parameters, CA-125 and Risk of Malignancy Index in Patients with Ovarian Cancer