The development of less toxic conditioning treatments, prevention of GVHD and effective infection control measures have resulted in many transplant patients surviving from a fatal disease and having an improved quality of life. For those patients who survive two years after transplantation, the risk of dying is still significantly higher than normal individuals of the same age group. The most common causes of death in this group of patients are recurrent malignancy, secondary malignancy, infection, chronic graft versus host disease, and respiratory and cardiovascular diseases. A listing of these conditions and their most likely causes is shown in the table.
Long term complications after HSC transplantation
Disease or Condition | Pathology |
Cardiovascular disease | Ionizing radiation, hypothyroidism, steroid therapy, growth hormone deficiency |
Secondary malignancy | Ionizing radiation, pre-transplantation chemotherapy |
Pulmonary disease | Injury to small airways and bronchioles as a result of chronic GVHD |
Infection | Failure of T and B cell systems in transplant immunosuppression of chronic GVHD |
Bone mineral loss | Steroid therapy, hypogonadism, chronic GVHD |
Ocular GVHD | Ionizing radiation, methotrexate |
Endocrine disorders (eg, diabetes mellitus, hypogonadism, thyroid disease, adrenal insufficiency, pituitary dysfunction) | Steroid therapy, ionizing radiation |
Chronic kidney disease | Ionizing radiation, steroid therapy, chronic GVHD |
Esophageal and swallowing problems | Steroid therapy, chronic GVHD |
Anorexia, nausea, vomiting | Infections, chronic GVHD |
Diarrhea and abdominal pain | Infections, chronic GVHD |
Liver disease | Infection, GVHD, iron overload, recurrent malignancy |
Biliary tract disease | Steroid therapy, GVHD, iron overload |
Iron overload (eg, heart, liver, pancreas, endocrine tissue) | Red cell transfusions |
Psychological issues | Post-traumatic stress, fear of relapse, chronic GVHD |
Cognitive decline | Ionizing radiation, inflammatory cytokines (tissue necrosis factor) |
Early detection of the complications that occur after transplantation is essential for HSC transplant patient’s long-term survival and quality of life. Laboratory professionals play a key role as members of the transplant team. All departments of the clinical laboratory help in the management of HSC patients. Whether it is hematology, blood bank, microbiology, clinical chemistry, immunology or anatomic pathology, the laboratory professionals working in these areas provide essential information that saves lives.
