Hematologic cancer survivorship management: Transplantation

Abstract

This chapter will review the late effects of treatment impacting hematopoietic stem cell transplantation (HSCT) survivors. In general, HSCT patients receive high doses of chemotherapy with or without radiation therapy to eradicate their malignancy, together with an infusion of their own (autologous) or another person’s (allogeneic) stem cells to restore hematopoiesis (the blood and immune system). Allogeneic cells may be from bone marrow, peripheral blood, or umbilical cord blood obtained from a related or unrelated donor. Patients experience the toxic effects of the cytotoxic treatment and are at high risk for infections owing to posttransplant immune deficiency. Late effects for HSCT survivors are commonly compounded by the toxic effects of their previous cancer treatment. This chapter will cover physiologic and psychological aspects of survivorship for HSCT patients, as well as graft-versus-host disease, a common and frequently chronic condition that occurs after allogeneic HSCT.