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Bone Marrow Transplant

 

 

Late Complications

 

BMT: Late Effects Overview

Late Effects from bone marrow transplant are due to a combination of therapy used in the conditioning regime (chemotherapy and radiation therapy) together with cGvHD. The original underlying disease also contributes to long term health risks such as osteoporosis. 

These health risks are multiple and complex. The table below outlines the majority of long term side effects experienced by BMT survivors.  It is reproduced from the late effects section, where there is also an overview of the screening and different therapies required by these patients:

Major health problems in BMT survivors and their etiology:

Organ System

Problem

Etiology
Kidney
  • Renal dysfunction and failure
  • RT to kidney
  • Intensive chemotherapy
  • Hypertension
  • Hypertension
  • Renal damage
  • Cranial RT
Thyroid
  • Hypothyroidism
  • RT to thyroid
  • Benign thyroid nodules
  • Papillary thyroid cancer
  • RT to thyroid

Metabolic Syndrome

 

 
  • Truncal obesity
  • Hypertension
  • Hyperlipidemia
  • Increased risk of diabetes
  • Increased risk of vascular disease (CVE or MI)
  • Cranial RT
Gonadal dysfunction
  • Hypogonadism:
  • Reduced sex hormone levels
  • RT to gonads
  • RT to pituitary and hypothalamus
  • Infertility

 
  • RT to gonads
  • High dose alkylating chemotherapy
CNS
  • Short term memory problems and cognitive dysfunction
  • Cranial RT
  • IT and IV Methotrexate
  • Increased risk of cerebrovascular event (CVE)
  • Cranial RT
  • Meningiomas
  • Cranial RT
Psychological
  • Depression
  • Illness and entire therapy

Skin/Nail

 
  • skin disease
  • cGvHD

Increased risk of skin cancers:

  • Melanoma
  • Non-melanoma
  • RT to skin
  • Chemotherapy

Oropharynx
  • Dry mouth (xerostomia) and accelerated dental decay
  • Abnormal tooth development in young children
  • RT to salivary glands
  • cGvHD

Eyes and lacrimal glands
  • Cataracts
  • RT to lens of eye
  • Dry and gritty eyes (sicca symptoms)
  • cGvHD

Gastrointestinal
  • Esophageal web
  • Malabsorption
  • cGvHD
  • Anemia (Fe deficiency)
  • Serum B12 deficiency
  • Malabsorption from cGvHD
  • Increased risk of colon cancer
  • RT

Hepatic
  • Infective hepatitis
  • Acquired Hepatitis B and C through contaminated blood products
  • Hepatitis/VOD
  • RT to liver
  • Intensive chemotherapy
  • cGvHD

Pulmonary
  • Interstitial lung disease
  • cGvHD
  • RT to lungs
Cardiac
  • Coronary artery disease
  • Metabolic syndrome
  • Hypertension
  • RT to heart

Bones

Muscles

Fascia

Joints
  • Short stature

 
  • RT at young age causes reduced growth of all structures within RT field
  • RT induced damage to pituitary and hypothalamus with reduced GH levels
  • Joint disease with contractures
  • cGvHD
  • Osteoporosis
  • Leukemia prior to BMT can infiltrate and damage bone
  • RT
  • Chemotherapy
  • Corticosteroids
  • Illness and inactivity
  • Malnutrition

Hematopoietic
  • Risk of secondary leukemia
  • RT
  • Alkylating agent chemotherapy
  • Abnormal blood count
  • Thrombocytopenia
  • cGvHD
  • Autoantibodies (ANA, anti-dsDNA, Coombs positive)

Immune System
  • Recurrent infections
  • cGvHD
Second Cancers
  • Development of a second malignant neoplasm
  • RT
  • cGvHD
 

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