Bone Marrow Transplant and GVHD
Introduction
Survivors of bone marrow transplant generally have multiple long term health problems related to:
- Conditioning therapy (chemotherapy and/or radiation therapy)
- Chronic graft versus host disease (cGvHD)
Other factors may also play a role:
- Previous malignancy
- Complications during transplant (such as infection and hypotension)
- Supportive care (for example, some antibiotics and antifungal drugs are nephrotoxic)
Usually these side effects overlap and produce significant morbidity.
One study assessed 162 survivors of HSCT seen at a single center and the cumulative incidence of late effects was 93.2% after a median follow-up time of 7.2 years after hematopoietic stem cell transplantation (HSCT). The burden of late effects was mild, moderate, severe and disabling in 28, 41, 24 and 1% of survivors respectively. Risk factors for a severe or disabling burden of late effects were older age at HSCT and a conditioning regimen that included irradiation1.
Late Effects of therapy:
Radiation therapy (RT):
Whole body low dose radiotherapy (often called Total Body Irradiation or TBI) can affect many organs and lead to multiple late effects. These side effects are exacerbated by the high dose chemotherapy also given as part of the conditioning regime.
Examples of long term health problems related to radiation therapy component of conditioning regime:
| Region affected by TBI | Long-term health Risk |
| General |
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| Skeletal |
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| Brain |
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| Eyes |
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Pituitary Hypothalamus |
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| Oral |
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| Thyroid |
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| Lungs |
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| Heart |
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| Kidneys |
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| Gonads |
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| Immune system |
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Chemotherapy:
Examples of late health problems related to the chemotherapy component of conditioning regime:
- Cyclophosphamide
- Infertility
- Increased risk of secondary leukemia
- Bleomycin
- Pulmonary damage
Chronic graft versus host disease (cGvHD):
