Hematologic complications associated with HSCT

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) is an increasingly used curative treatment modality, not only for hematologic malignancies but also for a variety of primary immunodeficiencies and nonmalignant hematologic disorders. The expanded use of HSCT is due in large part to improvements in supportive care, T cell depletion approaches, immune suppression, and disease-specific conditioning strategies that have led to improved survival for patients receiving HSCT using alternative donors such as unrelated cord blood, matched or mismatched unrelated adult donors, and partially matched or haploidentical-related donors. While significant hematologic complications associated with well-established approaches for myeloablative matched sibling donor (MSD)- HSCT are relatively uncommon, the increasing use of reduced-intensity conditioning and alternative donor HSCT has been associated with a significant rise in hematologic abnormalities following HSCT. These include autoimmune hemolytic anemia, alloimmune hemolysis due to donor/recipient ABO incompatibility, thrombocytopenia, transplant-associated microangiopathy (TAM), and thromboembolism. Thus, pediatric hematology/oncology specialists who care for pediatric patients who have received HSCT need to be aware of the common presentations and treatment options for hematologic disorders that occur post-HSCT. These HSCT-associated hematologic complications along with their diagnosis and management are discussed in this chapter.