![]() Lost in transition: the essential need for long-term follow-up clinic for blood and marrow transplantation survivors. Hashmi S, Carpenter P, Khera N, Tichelli A, Savani BN. Hematopoietic stem cell transplantation: a global perspective. ![]() Gratwohl A, Baldomero H, Aljurf M, Pasquini MC, Bouzas LF, Yoshimi A et al. Hematopoietic SCT in Europe 2013: recent trends in the use of alternative donors showing more haploidentical donors but fewer cord blood transplants. Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P et al. Blood and Marrow Transplantation Long Term Management: Prevention and Complications. How can we improve life expectancy and quality of life in long-term survivors after allogeneic stem cell transplantation? Semin Hematol 2012 49: 1–3. This article will review in a non-exhaustive manner, the approach to long-term care of an allo-HSCT recipient. These patients represent a distinct, high-risk population that must be monitored for long-term transplant complications, including chronic GvHD (cGvHD), multi-organ dysfunctions and secondary malignancies. For survivors >2 years removed, the time of transplant all-cause mortality is four- to nine-fold higher than age-matched peers within the general population. These patients have survived the acute critical phase of transplantation and have potentially achieved remission from their primary disease, yet allo-HSCT patients do not return to pre-transplant health status. With the expansion in the number of long-term survivors, as well as of those considering a transplant, the focus of transplant medicine has been shifted significantly to include a more prominent role for the care of the ‘long-term’ survivor. Over the past several decades, significant technological and post-transplant supportive advances have been made, resulting in a decrease in early transplant mortality and continued growth in the population of allo-HSCT survivors. But improvements in the way the cells are prepared and matched and in the care of the person after the transplant have helped reduce problems.Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for over 70 benign and malignant hematologic and immunological processes. Symptoms include swelling and tenderness of the liver, weight gain, jaundice, and fluid buildup in the belly.Ī transplant from an unrelated donor is more likely to cause problems. This is a serious liver problem caused by the high dose of chemotherapy or radiation given before a transplant. GVHD does not occur when an identical twin is the donor. GVHD is treated with medicine that lowers the activity of your immune system. ![]() GVHD affects the skin, gastrointestinal tract, and liver. After chronic GVHD occurs, it may take as long as 3 years to go away. If it happens after 3 months, it is called chronic GVHD. If it happens within 3 months, it is called acute GVHD. The new stem cells attack other cells in your body. If this occurs, the likelihood of a cure is low. The new stem cells don't work, or they work for a short time and then fail. Serious, long-term complications of an allogeneic transplant include: Recurrence of the disease that the transplant was used to treat.Infection, such as pneumonia, shingles, or herpes simplex.Bleeding, because of a severe decrease in red blood cells, white blood cells, and platelets.Waiting for the transplanted stem cells to produce healthy blood cells.Įarly complications of both allogeneic and autologous transplants usually occur within 5 to 10 days.Having chemotherapy (sometimes along with radiation) to destroy cancer cells or damaged stem cells.The new cells can come from the blood, bone marrow, or umbilical cord blood. The allogeneic transplant process includes: If your bone marrow is damaged or destroyed, it can no longer make normal blood cells.Ī stem cell transplant may be used to treat diseases that damage or destroy the bone marrow, such as non-Hodgkin lymphoma and Hodgkin lymphoma, leukemia, multiple myeloma, and aplastic anemia. Bone marrow stem cells turn into red blood cells, white blood cells, or platelets to help your body stay healthy. You also have some that circulate from your marrow into your blood. This is more likely when the donor is your brother or sister. The important thing is that the donor's immune system markers are closely matched to yours. When they come from another person, it's called an allogeneic stem cell transplant. The transplant can use stem cells that come from your own blood or bone marrow. In a stem cell transplant, healthy stem cells are placed in your body through an IV to help your bone marrow start to work as it should.
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