title: Long-term follow-up after allogeneic stem cell transplantation.
abstract: BACKGROUND
  Over 3000 persons undergo allogeneic hematopoietic stem-cell transplantation (allo-HSCT) in Germany every year. Advances in allo-HSCT have prolonged the survival of treated patients but have concomitantly increased the risk of long-term complications that impair their quality of life.
  
  
  METHODS
  This literature review of the long-term sequelae of allo-HSCT is based on pertinent articles that were retrieved by a selective search of PubMed, and on current international guidelines. Case reports were excluded from consideration.
  
  
  RESULTS
  Hardly any randomized clinical trials have been performed to investigate the long-term outcome of allo-HSCT, but international consensus-based guidelines have been published. 50% to 70% of patients treated with allo-HSCT develop chronic graft-versus-host disease (cGVHD) within ten years of treatment. Transplant recipients are at higher risk of infection, including the reactivation of dormant herpes viruses; therefore, vaccination is recommended, as described in the current guidelines. Gonadal dysfunction arises in up to 92% of men and up to 99% of women; its frequency depends on the timing of transplantation, on radiotherapy, and on other factors. The medications that transplant recipients need to take can impair liver function, and transfusionassociated hemosiderosis can do so as well. 40% to 50% of patients suffer from lipid metabolic disturbances that increase the risk of myocardial infarction, peripheral arterial occlusive disease, and stroke. Their life expectancy is shorter than that of the overall population.
  
  
  CONCLUSIONS
  Measures should be taken to prevent the potential long-term complications of allo-HSCT. All patients who have been treated with allo-HSCT should receive individualized, risk-adapted, and multidisciplinary follow-up care, so that any complications that arise can be correctly diagnosed and appropriately treated. Long-term follow-up care could be improved by prospective clinical trials investigating the long-term sequelae of allo-HSCT, as well as by consistent, uniform documentation of these sequelae in supraregional data registries.
authors: Clinic of Internal Medicine II, University Hospital Jena, University Clinic of Internal Medicine I, Medical University of Vienna, Austria, Department of Hematology, University Hospital of Basel, St. Anna Children's Hospital, Vienna, Austria, Department of Hematology, Oncology, and Stem-Cell Transplantation, Medical Center - University of Freiburg, Department of Internal Medicine III, University Hospital Regensburg.
authors: Inken
authors: I
authors: Hilgendorf
authors: Hildegard
authors: H
authors: Greinix
authors: Jörg P
authors: JP
authors: Halter
authors: Anita
authors: A
authors: Lawitschka
authors: Hartmut
authors: H
authors: Bertz
authors: Daniel
authors: D
authors: Wolff
mesh_terms: D064591:Allografts / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D004700:Endocrine System Diseases / Q000401:mortality*; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006084:Graft Rejection / Q000401:mortality*; D006086:Graft vs Host Disease / Q000401:mortality*; D006801:Humans; D008107:Liver Diseases / Q000401:mortality*; D008137:Longitudinal Studies; D011788:Quality of Life; D018570:Risk Assessment; D033581:Stem Cell Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome; D014777:Virus Diseases / Q000401:mortality*