Cardiovascularcomplications-HCT survivors havean increased risk for cardiovascularcomplications such as coronary artery disease, peripheral arterial disease andcardiomyopathy.
There is a 2-fold increase in risk of cardiovascular deathamong HCT survivors compared with the general population. Early onsetcardiovascular events are primarily due to accelerated atherosclerosis due toradiation (pre-transplant or total body irradiation as a part of transplantconditioning regimen). HCTsurvivors also have a high prevalence of metabolic syndrome which represents acluster of risk conditions associated with premature coronary artery disease.
Education and counseling on “heart Healthy” lifestyleincluding a regular exercise, healthy dietary habits and screening fordyslipidemia, diabetes and hypertension should be recommended to all HCTsurvivors. Routine clinical assessment of cardiovascular risk factors isstrongly recommended at 12 months post-transplant and annually afterwards. In asymptomaticadults without any cardiac risk factors, cardiac imaging tests are notrecommended.
More frequent assessments and if clinically appropriate, further cardiacevaluations may be indicated in patients at high-risk for cardiac complicationsincluding patients who had mediastinal radiation, patients with amyloidosis,and those with pre-existing cardiac and vascular complications.EndocrineComplications–Thyroid dysfunction Thyroid dysfunction is among the most commonlong-term endocrine complications post autologous and allogeneic HCT. Total body radiation (TBI), youngerage at transplant and presence of GVHD are the most recognized risk factors forthyroid dysfunction after HCT. Based on international blood and marrowtransplant guidelines, thyroid function assessment is recommended yearly after HCTindefinitelyor in presence of relevant symptoms.
Gonadaldysfunction isvery common in HCT, recipients affecting as high as 92% for males and 99% forfemales. Age at transplantation, gender, pre-transplant therapy and intensityof conditioning regimen (especially high dose irradiation and busulfan) influencethe degree of gonadal dysfunction. Women who were post-pubertal at thetime of transplantation should have clinical and endocrinologic gonadalassessment 1 year after HCT. Subsequent assessment should be guided bymenopausal status.
Gonadalfunction in men (FSH, LH, and testosterone) is warranted by symptoms. Skeletalcomplications-Lossof bone density is a well-known complication of HCT with reported incidencerates as high as 25% for osteoporosis and 50% for osteopenia in some studies. Olderage, female gender, low body mass index, physical inactivity and prolongedsystemic corticosteroids exposure (? 5 mg prednisone equivalent daily for >3months) are well-recognized risk factors. Dual photon densitometry (DEXA scan)for adult women, all allogeneic HCT recipients, and patients at high risk ofbone loss after HCT is recommended one year post HCT. Subsequent testing isdetermined by the findings of first DEXA Scan or to assess therapy response.Education and counseling of HCT survivors about physical activity, vitamin Dand calcium supplementation is highly recommended to prevent bone density loss.
Avascularnecrosis (ANV) of the bone is another debilitating skeletal compilation postallogeneic 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 conditioningregimen has been associated with AVN. Joint pain and discomfort is the firstmanifestation of AVN. Most commonly affected joints are hips (more than 80% ofcases), knees and wrists. Standard imaging (X-ray) may not detect theabnormality until late stages of the disease. Thus, MRI imaging in patientswith persistent joint pain with higher risk of AVN for early detection andprompt referral to an orthopedic specialist is recommended.