With the increased use of HSCT there is a rising population of survivors worldwide. Lifetime surveillance and management of transplant recipients is necessary to ensure ongoing quality of life and longevity. Key supportive care needs identified in HSCT survivors include fatigue, psychological distress, occupational and financial issues, and sexuality and fertility concerns.46
There are numerous models of survivorship care. Essential features of high quality services include comprehensiveness, a coordinated approach, and individualised, holistic care provision.47 Long term follow-up should include assessment of psychological symptoms, quality of life, sexual function, fertility, and inquiring into the individual’s personal support network, in addition to screening for major organ dysfunction and second malignancies.46
Potential late effects
The late effects summarised in this section are those experienced 5 or more years after HSCT.48
Ophthalmologic late effects
- Sicca syndrome (dry eye)
- cataracts are a common late effect, often related to total body irradiation or steroid use.
Pulmonary late effects
- ongoing restrictive or obstructive changes related to infections and pulmonary complications within two years of HSCT
- conditions include chronic bronchitis, hepatopulmonary syndrome, bronchiolitis obliterans, pulmonary fibrosis, and idiopathic pneumonia syndrome.
Endocrine late effects
- gonadal dysfunction
- ovarian failure
- thyroid dysfunction
- growth hormone deficiency.
Gastrointestinal late effects
- dry mucous membranes.
Musculoskeletal late effects
- avascular necrosis
- diminished bone mineral density
Neurocognitive late effects
- cognitive dysfunction.
Secondary malignant neoplasm
A devastating late effect of HSCT is the development of a secondary malignant neoplasm (SMN). In the first decade after HSCT, the recipient is at risk of:
- post-transplant lymphoproliferative disorders (PTLD)
- myelodysplasia (MDS)
- acute myeloid leukaemia (AML).
- Summarise the principles of optimal survivorship care
- Describe potential roles for the SCN in survivorship care of the individual post HSCT
- Outline barriers to optimal survivorship care
- Discuss recommendations to improve survivorship care.
- Identify the yearly assessments and tests required of the recipient of an allogeneic transplant at five years post-transplant
- Discuss the potential psychosocial impact of long term follow up.
Access a current text and Late effects in survivors of Hodgkin and Non-Hodgkin Lymphoma treated with autologous hematopoietic cell transplantation: a report from the bone marrow transplant survivor study52, and:
- Identify three long term issues (excluding graft-versus-host disease) experienced by individuals post HSCT
- Summarise the evidence regarding the incidence and impact of each issue
- Discuss the potential role of the SCN pre and post HSCT in the counselling, education, early identification, and management of these long term issues.