<LEsBMTHealthRisks>

The chronic health risks after BMT are for the most part due to radiation therapy (RT) and intensive chemotherapy given in the conditioning regime prior to transplant and also to cGvHD.

A study of the European Bone Marrow Transplant Registry showed that patients who survived more than 5 years after transplantation had an increased risk of death compared to normal.

Causes of death were related to:

Relapse of the underlying cancer
Development of a second cancer
Chronic GVHD
Transfusion-acquired viral infection.

Certain patients were at high risk for severe late effects:

Males
Recipients of stem cells from female donors
Patients younger than 10 years at time of transplant
Patients with non-identical donors
Patients give radiation therapy (RT) in conditioning regime.

Frequency of different long-term health problems in BMT survivors:
Approx. % of survivors affected	Chronic Health condition
50%	Immunodeficiency Renal dysfunction Cataracts Chronic GVHD
20 - 50%	Endocrine dysfunction Infertility Delayed sexual development Oral and dental problems Psychosocial stress
Less than 20%	Secondary malignant neoplasms Cognitive disorders Avascular necrosis of the hips and other joints Pulmonary dysfunction

The following table outlines major health problems in BMT survivors and their etiology:

Organ System	Problem	Etiology
Kidney	Renal dysfunction and failure	RT to kidney Intensive chemotherapy Hypertension
Kidney	Hypertension	Renal damage Cranial RT
Thyroid	Hypothyroidism	RT to thyroid
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
Gonadal dysfunction	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
Skin/Nail	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
Eyes and lacrimal glands	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 hepatits	Acquired Hepatitis B and C through contaminated blood products
Hepatic	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
	Short stature	RT induced damage to pituitary and hypthalamus 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
Hematopoietic	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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