Blood and Marrow Transplantation Long Term Management

Survivorship after Transplant

Second Edition

EDITED BY

Bipin N. Savani

Vanderbilt University Medical Center

Nashville, TN, USA

André Tichelli

University Hospital Basel

Basel, Switzerland

This edition first published 2021 © 2021 John Wiley & Sons Ltd

Edition History John Wiley & Sons Ltd (1e, 2013)

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Library of Congress Cataloging‐in‐Publication Data

Names: Savani, Bipin N., editor. | Tichelli, André, editor.

Title: Blood and marrow transplantation long term management : survivorship after transplant / edited by Bipin N Savani, André Tichelli.

Description: Second edition. | Hoboken, NJ : Wiley‐Blackwell, 2021. | Includes bibliographical references and index.

Identifiers: LCCN 2020053132 (print) | LCCN 2020053133 (ebook) | ISBN 9781119612698 (hardback) | ISBN 9781119612742 (adobe pdf) | ISBN 9781119612735 (epub)

Subjects: MESH: Hematopoietic Stem Cell Transplantation–adverse effects | Long Term Adverse Effects–prevention & control | Disease‐Free Survival | Survivors

Classification: LCC RD123.5 (print) | LCC RD123.5 (ebook) | NLM WH 380 | DDC 617.4/410592–dc23

LC record available at https://lccn.loc.gov/2020053132LC ebook record available at https://lccn.loc.gov/2020053133

Cover Design: Wiley

Cover Image: Bipin N. Savani and André Tichelle

by Professor John Barrett

Since 2013 when the publication of the first edition of Savani’s Blood and Marrow Transplantation Long Term Management: Prevention and Complications the accelerated pace of stem cell transplant activity worldwide since the beginning of this century, together with the continuing trend to reduced early mortality from the procedure has translated into an almost exponential expansion in the number of long term survivors which must now number well beyond half a million individuals surviving more than five years. More than ever, to serve our patients we need this authoritative guide for the management of our long‐term survivors as well as a comprehensive and contemporaneous account of the causative factors of long‐term complications that can inform us of better ways to do stem cell transplants.

What have we learned in the last few years? Chronic graft‐versus‐host disease (C‐GVHD) is increasingly recognized as a cause of late effects not hitherto ascribed to this common post‐transplant event. It is now clear that human papilloma virus (HPV) contributes to a significant proportion of the second malignancies which relentlessly increase over time after transplant. Understanding the impact of these two risk factors is important in focusing efforts to avoid C‐GVHD, and by using post‐transplant HPV vaccination to reduce second malignancies. As observational studies of long‐term survivors accumulate, we are discovering new late effects extending beyond the familiar territories of GVHD and second tumors. In this newest edition, the section of organ‐specific late effects is greatly expanded. In particular delayed cardiovascular events are being defined, as well as a much clearer idea of the psychosocial and economic burden that long‐term survivors and their carers may experience. Finally, we are beginning to distinguish different trajectories of late effects due to particular transplant approaches. Over and above the well characterized differences on late outcomes after autologous versus allogeneic SCT databases are extensive enough to identify the impact of different and newer transplant approaches for example haplo‐identical donor transplants.

All this new information and increased competence in managing as well as preventing transplant late effects could not have been possible without a concerted effort from all the major transplant registries and societies to concentrate on the problem. This has led to the development of useful guidelines, dedicated multidisciplinary late effect clinics, and a gratifyingly broader knowledge base among transplant physicians and primary caregivers, which in turn leads to better patient management. The first section of this book captures the contribution by the world’s registries as well as provides a helpful guide to establishing a comprehensive long‐term follow‐up program including the application of telemedicine to this discipline.