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Follow-up for patients after allogeneic stem cell transplantation

Follow-up

The patient should contact their doctor if they have the following symptoms:

  • rash
  • fever
  • sudden and lasting cough
  • shortness of breath
  • unexpected bleeding
  • sudden diarrhea, significant constipation, abdominal pain, nausea
  • mouth soreness, significant sore throat, or problems swallowing
  • pain associated with urination or bowel movements
  • acute headache
  • pain limited to an area in the face/body
  • contact with possible infectious illness

Delayed reactions after stem cell transplantation (after 1 year)

Chronic GVHD

About 30% develop GVHD, 1/3 are new cases, 1/3 are recurrence of acute GVHD, 1/3 are lasting acute GVHD. GVHD occurs more frequently with unrelated donors.

Infections

The patient should be revaccinated according to the standard vaccination program after 1 year. The patient should not be inoculated with live vaccine.

Infections in the form of Herpes zoster, CMV and encapsulated bacteria are rare, but occur if the patient has chronic GVHD.

For confirmed hypogammaglobulinemia and recurrence of serious infections, gammaglobulin substitution may be necessary.  

Lung complications

Moderate to serious restrictive loss of function in about 20%, especially in patients with chronic GVHD.

Lung complications with obstructive failure, obliterating bronchiolitis in < 5 %, is observed especially in patients with chronic GVHD. The most important treatment is early infection therapy. Effect of increased immunosuppression is uncertain and this type of treatment requires increased attention with regard to infections.  

Hemosiderosis

Hemosiderosis is caused by numerous erythrocyte transfusions and may cause long-term organ damage. Blood-letting is therefore performed with ferritin > 500, from about 6 months after the transplantation, if the patient will tolerate it. Blood is drawn until ferritin is at a stable level within the normal reference area.

Hypothyroidism

About 15% will become hypothyroid (preferable monitored after TBI).

Gonadal function, growth and development

All stem cell transplanted women will have a follow-up program at the women's clinic.

Almost all women remain in amenorrhea and half will develop menopausal symptoms.

Almost all stem cell transplanted men develop gonad failure with azospermia. Restitution of gonad function after multiple years has been observed in some cases.

Possible pregnancy

The risk for fetal injury at birth and the first years after birth do not appear to have increased. Long-term observations indicate that the risk of fetal injury is not great.

Cataract

Cataracts occur in most long-term survivors after total body irradiation. The frequency after busulfan and cyclophosphamide is still uncertain, but is not uncommon.

Leukemia recurrence

Very rare after 2-3 years, but can occur even after > 6 years.

Secondary neoplasia

  • Cumulative risk after 15 years, 6% with out total body irradiation, 20% with total body irradiation.
  • Lymphoid neoplasms in donor cells occur in rare cases and are often associated with EBV. This usually occurs within a year after a transplantation and especially in patients who have received T-cell filtered marrow with HLA-incompatibility and who are treated for steroid-refractory acute GVHD.
  • Basal cell and squamous cell carcinoma
  • Leukemia in donor cells < 1%

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