Types of late complications: tissues affected, risk factors, prevention, and treatment.
| Tissue/Organs . | Late Complications . | Risk Factors . | Preventive Measures . | Treatment Options . |
|---|---|---|---|---|
| Abbreviations: GVHD, graft-versus-host disease; PCP, Pneumocystis carinii pneumonia; TBI, total body irradiation; CNS, central nervous system; CMV, cytomegalovirus | ||||
| Immunity | Infections | GVHD | Antibiotic prophylaxis | Targeted antimicrobials for specific infectious pathogens |
| T cell depletion | Immunizations | |||
| Herpesvirus infection | Optimization of matching | |||
| Donor source | PCP prophylaxis | |||
| Histocompatibility of donor and recipient | ||||
| Autoimmune syndromes | GVHD | Optimization of matching | IVIG for autoimmune thrombocytopenia | |
| Steroids for various autoimmune phenomena | ||||
| Endocrine glands | Hypothyroidism | Radiotherapy to head, neck, & mantle | Fractionation of TBI | Thyroid replacement |
| TBI | Annual thyroid screening | |||
| Hypoadrenalism | Prolonged corticosteroid use | Replacement steroids for surgical procedures or acute medical conditions | ||
| Gonadal failure | TBI, intensive chemotherapy | Sperm banking | Hormone replacement | |
| Skeletal | Osteopenia | Prolonged corticosteroid usage, TBI, inactivity, ovarian hormonal failure | Screening densitometry, exercise, bisphosphonates, | Bisphosphonates ovarian hormonal replacement |
| Avascular necrosis | Corticosteroid usage, male gender, age >16 | Minimization of steroids | Joint replacement of affected weight bearing joints | |
| Liver | GVHD Hepatitis B or C Iron overload | Hepatitis A & B vaccines hepatitis C | Lamivudine or foscarnet for hepatitis B; interferon plus ribavirin for hepatitis C | |
| Ophthalmologic | Cataracts | TBI, busulfan, corticosteroids | Extraction and lens implantation ointment | |
| Keratoconjunctivitis | GVHD | Artificial tear solution and ointment | ||
| Musculature | Myopathy Myositis | Corticosteroid therapy Chronic GVHD | Minimization of corticosteroids Exercise | |
| Nervous system | Leukoencephalopathy | Cranial radiotherapy Intrathecal chemotherapy Fludarabine | ||
| Peripheral neuropathy | GVHD | Cranial radiotherapy | Corticosteroid therapy | |
| Respiratory tract | Interstitial fibrosis | Intensive conditioning regimen GVHD | ||
| Bronchiolitis obliterans | GVHD | Immunosuppressive therapy | ||
| Growth | Short stature | CNS irradiation TBI (single dose rather than fractionated) Hypothyroidism Corticosteroid therapy Gonadal insufficiency | Periodic assessment of endocrine status | Hormone replacement |
| Dentition | Cavities Sicca syndrome | Chronic GVHD | Dental hygiene | Artificial saliva |
| Bladder | Scarring after hemorrhagic cystitis | Cyclophosphamide, BK virus, adenovirus, CMV administration | Hyperhydration or mesna Cyclophosphamide | Antispasmodics for symptomatic relief |
| Kidneys | Nephropathy | TBI, prior platinum compounds enzyme inhibitors | Angiotension-converting | Control of hypertension |
| Tissue/Organs . | Late Complications . | Risk Factors . | Preventive Measures . | Treatment Options . |
|---|---|---|---|---|
| Abbreviations: GVHD, graft-versus-host disease; PCP, Pneumocystis carinii pneumonia; TBI, total body irradiation; CNS, central nervous system; CMV, cytomegalovirus | ||||
| Immunity | Infections | GVHD | Antibiotic prophylaxis | Targeted antimicrobials for specific infectious pathogens |
| T cell depletion | Immunizations | |||
| Herpesvirus infection | Optimization of matching | |||
| Donor source | PCP prophylaxis | |||
| Histocompatibility of donor and recipient | ||||
| Autoimmune syndromes | GVHD | Optimization of matching | IVIG for autoimmune thrombocytopenia | |
| Steroids for various autoimmune phenomena | ||||
| Endocrine glands | Hypothyroidism | Radiotherapy to head, neck, & mantle | Fractionation of TBI | Thyroid replacement |
| TBI | Annual thyroid screening | |||
| Hypoadrenalism | Prolonged corticosteroid use | Replacement steroids for surgical procedures or acute medical conditions | ||
| Gonadal failure | TBI, intensive chemotherapy | Sperm banking | Hormone replacement | |
| Skeletal | Osteopenia | Prolonged corticosteroid usage, TBI, inactivity, ovarian hormonal failure | Screening densitometry, exercise, bisphosphonates, | Bisphosphonates ovarian hormonal replacement |
| Avascular necrosis | Corticosteroid usage, male gender, age >16 | Minimization of steroids | Joint replacement of affected weight bearing joints | |
| Liver | GVHD Hepatitis B or C Iron overload | Hepatitis A & B vaccines hepatitis C | Lamivudine or foscarnet for hepatitis B; interferon plus ribavirin for hepatitis C | |
| Ophthalmologic | Cataracts | TBI, busulfan, corticosteroids | Extraction and lens implantation ointment | |
| Keratoconjunctivitis | GVHD | Artificial tear solution and ointment | ||
| Musculature | Myopathy Myositis | Corticosteroid therapy Chronic GVHD | Minimization of corticosteroids Exercise | |
| Nervous system | Leukoencephalopathy | Cranial radiotherapy Intrathecal chemotherapy Fludarabine | ||
| Peripheral neuropathy | GVHD | Cranial radiotherapy | Corticosteroid therapy | |
| Respiratory tract | Interstitial fibrosis | Intensive conditioning regimen GVHD | ||
| Bronchiolitis obliterans | GVHD | Immunosuppressive therapy | ||
| Growth | Short stature | CNS irradiation TBI (single dose rather than fractionated) Hypothyroidism Corticosteroid therapy Gonadal insufficiency | Periodic assessment of endocrine status | Hormone replacement |
| Dentition | Cavities Sicca syndrome | Chronic GVHD | Dental hygiene | Artificial saliva |
| Bladder | Scarring after hemorrhagic cystitis | Cyclophosphamide, BK virus, adenovirus, CMV administration | Hyperhydration or mesna Cyclophosphamide | Antispasmodics for symptomatic relief |
| Kidneys | Nephropathy | TBI, prior platinum compounds enzyme inhibitors | Angiotension-converting | Control of hypertension |