complications-HCT survivors have
an increased risk for cardiovascular
complications such as coronary artery disease, peripheral arterial disease and
cardiomyopathy. There is a 2-fold increase in risk of cardiovascular death
among HCT survivors compared with the general population. Early onset
cardiovascular events are primarily due to accelerated atherosclerosis due to
radiation (pre-transplant or total body irradiation as a part of transplant
conditioning regimen). HCT
survivors also have a high prevalence of metabolic syndrome which represents a
cluster of risk conditions associated with premature coronary artery disease.
Education and counseling on “heart Healthy” lifestyle
including a regular exercise, healthy dietary habits and screening for
dyslipidemia, diabetes and hypertension should be recommended to all HCT
survivors. Routine clinical assessment of cardiovascular risk factors is
strongly recommended at 12 months post-transplant and annually afterwards. In asymptomatic
adults without any cardiac risk factors, cardiac imaging tests are not
recommended. More frequent assessments and if clinically appropriate, further cardiac
evaluations may be indicated in patients at high-risk for cardiac complications
including patients who had mediastinal radiation, patients with amyloidosis,
and those with pre-existing cardiac and vascular complications.
Complications–Thyroid dysfunction Thyroid dysfunction is among the most common
long-term endocrine complications post autologous and allogeneic HCT. Total body radiation (TBI), younger
age at transplant and presence of GVHD are the most recognized risk factors for
thyroid dysfunction after HCT. Based on international blood and marrow
transplant guidelines, thyroid function assessment is recommended yearly after HCTindefinitely
or in presence of relevant symptoms.
very common in HCT, recipients affecting as high as 92% for males and 99% for
females. Age at transplantation, gender, pre-transplant therapy and intensity
of conditioning regimen (especially high dose irradiation and busulfan) influence
the degree of gonadal dysfunction. Women who were post-pubertal at the
time of transplantation should have clinical and endocrinologic gonadal
assessment 1 year after HCT. Subsequent assessment should be guided by
menopausal status. Gonadal
function in men (FSH, LH, and testosterone) is warranted by symptoms.
of bone density is a well-known complication of HCT with reported incidence
rates as high as 25% for osteoporosis and 50% for osteopenia in some studies. Older
age, female gender, low body mass index, physical inactivity and prolonged
systemic corticosteroids exposure (? 5 mg prednisone equivalent daily for >3
months) are well-recognized risk factors. Dual photon densitometry (DEXA scan)
for adult women, all allogeneic HCT recipients, and patients at high risk of
bone loss after HCT is recommended one year post HCT. Subsequent testing is
determined by the findings of first DEXA Scan or to assess therapy response.
Education and counseling of HCT survivors about physical activity, vitamin D
and calcium supplementation is highly recommended to prevent bone density loss.
necrosis (ANV) of the bone is another debilitating skeletal compilation post
allogeneic HCT with a cumulative incidence of 3% to 10% at 5 years after HCT.
In addition to risk factors for osteoporosis , TBI as a part of conditioning
regimen has been associated with AVN. Joint pain and discomfort is the first
manifestation of AVN. Most commonly affected joints are hips (more than 80% of
cases), knees and wrists. Standard imaging (X-ray) may not detect the
abnormality until late stages of the disease. Thus, MRI imaging in patients
with persistent joint pain with higher risk of AVN for early detection and
prompt referral to an orthopedic specialist is recommended.