Late effects post-allogeneic hematopoietic stem cell transplantation

Advances in allogeneic hematopoietic cell transplantation (HCT) have increased the curative potential of the procedure and HCT survivors are living longer at a cost of a higher burden of late complications. This chapter discusses the basic concepts of non-relapse late effects, including the role of chronic graft-versus-host disease (cGVHD) in late effects. The late effects of cGVHD occur in a nonsystematic fashion. The exact pathogenesis of the late effects manifested as organ-specific cGVHD are complex. The risks of acute infections are heightened by mucocutaneous damage, which occurs due to skin, oral, and gastrointestinal cGVHD, and due to iatrogenic reasons. The oral mucosal involvement with GVHD frequently leads to extreme xerostomia, often resulting in pain secondary to aphthous-like ulcers. Late liver effects following allogeneic-HCT include cGVHD, viral hepatitis, and drug-induced hepatitis. The HCT survivors and their caregivers are at a significant risk of psychological disorders.