Late effects of chronic graft-versus-host disease.
Hematopoietic-cell transplantation (HCT) has become applicable to a broader range of ages and underlying diagnoses through advances in the utilization of alternative donors and stem-cell sources, reduced-intensity preparative regimens, and improved supportive care. The reduction in early transplant-related mortality means that more survivors will potentially develop chronic graft-versus-host disease (cGVHD) and associated late effects. Recipients of HCT are at risk for late end-organ dysfunction as a complication of chemoradiotherapy given before HCT, but disturbances are often multifactorial. This review focuses on problems arising predominantly as a result of cGVHD and its therapies. Disabilities caused by severe or inadequately treated cGVHD include keratoconjunctivitis sicca, bronchiolitis obliterans, skin ulcers, joint contractures, esophageal and vaginal stenosis, osteoporosis, avascular necrosis, and others. Almost all organ systems may be involved, and a broad approach is needed to allow recognition and anticipation of problems so that prevention or early intervention is possible.
Carpenter
Paul A
PA
Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Mailstop D5-290, Seattle, WA 98107, USA. pcarpent@fhcrc.org
D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000150:complications* / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D013997:Time Factors
D007166:Immunosuppressive Agents