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The approach to hematopoietic cell transplantation survivorship

Author
Corey Cutler, MD, MPH, FRCP(C)
Section Editor
Larissa Nekhlyudov, MD, MPH
Deputy Editor
Alan G Rosmarin, MD

INTRODUCTION

Hematopoietic cell transplantation (HCT) refers to the administration of hematopoietic progenitor cells from any source (eg, bone marrow, peripheral blood, umbilical cord blood) or donor (eg, allogeneic, autologous) to reconstitute the bone marrow. Autologous HCT uses hematopoietic progenitor cells derived from the individual with the disorder. By contrast, allogeneic HCT uses hematopoietic progenitor cells collected from someone other than the individual with the disorder. Autologous and allogeneic HCT are used increasingly to treat a variety of hematologic neoplasms, nonmalignant marrow disorders, and inborn errors of metabolism. Worldwide, there are more than 40,000 HCTs performed each year.

Coupled with the increased volume of HCT has been a steady improvement in allogeneic transplant outcomes, related largely to refinement in human leukocyte antigen (HLA) matching, improved supportive care, and advances in infectious disease therapy. As a result, there are a growing number of long-term survivors of HCT, and the transplant community has recognized the importance of providing specialized care to these individuals. (See "Management of the hematopoietic cell transplant recipient in the immediate post-transplant period", section on 'Estimating mortality risk'.)

The quality of life among patients who have undergone autologous HCT is generally excellent. Similarly, the majority of long-term survivors of allogeneic HCT are employed and in reasonably good health, with acceptable objective and subjective function. However, the HCT process exposes these patients to highly toxic therapy and puts them at risk for several long-term complications not routinely seen after conventional doses of chemotherapy and/or radiotherapy. In addition, allogeneic transplant recipients are subject to the long-term consequences of chronic graft-versus-host disease (GVHD), which may require specialized care for many years, even when quiescent or resolved. (See "Quality of life following hematopoietic cell transplantation" and "Clinical manifestations, diagnosis, and grading of chronic graft-versus-host disease".)

This topic review will provide an overview to the care of the HCT survivor, focusing on issues that require attention at approximately one year from HCT onwards. Specific care of the early complications of transplantation, the clinical care of acute and chronic GVHD, and the long-term disease-specific follow-up are discussed elsewhere, as is a more in-depth discussion of secondary malignancies after HCT. (See "Management of the hematopoietic cell transplant recipient in the immediate post-transplant period" and "Hematopoietic support after hematopoietic cell transplantation" and "Prevention of acute graft-versus-host disease" and "Treatment of chronic graft-versus-host disease" and "Malignancy after hematopoietic cell transplantation".)

TERMINOLOGY

Hematopoietic cell transplantation (HCT) is a general term for a variety of procedures in which the patient is treated with chemotherapy and/or radiation therapy (ie, the "preparative regimen") followed by the infusion of hematopoietic progenitor cells. HCT can be broadly divided into subtypes based upon the hematopoietic cell donor, the source of hematopoietic progenitor cells, and the preparative regimen. Each of these factors influences efficacy and the short- and long-term toxicities associated with the procedure.

                           

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Literature review current through: Nov 2016. | This topic last updated: Thu Jul 16 00:00:00 GMT+00:00 2015.
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