Blood and Marrow Transplantation Long Term Management

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Hematopoietic cell transplantation (HCT) provides curative therapy for a variety of diseases. Over the past several decades, significant advances have been made in the field of HCT, to the point where HCT has become an integral part of treatment modality for a variety of hematologic malignancies and some nonmalignant diseases. HCT remains an important treatment option for a wide variety of hematologic and nonhematologic disorders, despite recent advances in the field of immunologic therapies. Factors driving this growth include expanded disease indications, greater donor options (expanding unrelated donor registries and haploidentical HCT), and accommodation of older and less fit recipients. 
The development of less toxic pretransplant conditioning regimens, more effective prophylaxis of graft-versus-host disease (GVHD), improved infection control, and other advances in transplant technology have resulted in a rapidly growing number of transplant recipients surviving long-term free of the disease for which they were transplanted. The changes over decades in the transplant recipient population and in the practice of HCT will have almost inevitably altered the composition of the long-term survivor population over time. Apart from an increasingly older transplant recipient cohort, the pattern of transplant indications has shifted from the 1990s when chronic myeloid leukemia made up a significant proportion of allo-HCT indications. Changes in cell source, donor types, conditioning regimens, GVHD prophylaxis, and supportive care have all occurred, with ongoing reductions in both relapse and non-relapse mortality (NRM) have been demonstrated. 
These patients have increased risks for a variety of late complications, which can cause morbidity and mortality. Most long-term survivors return to the care of their local hematologists/oncologists or primary care physicians, who may not be familiar with specialized monitoring and management of long complications after HCT for this patient population. As HCT survivorship increases, the focus of care has shifted to the identification and treatment of long-term complications that may affect quality of life and long-term morbidity and mortality. 
Preventive care as well as early detection and treatments are important aspects to reducing morbidity and mortality in long-term survivors after allo-HCT. This second edition, 
, provides up-to-date information about diagnosis, screening, treatment, and long-term surveillance of long-term survivors after HCT.

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Table of Contents

1 Cover

2 Title Page

3 Copyright Page

4 Foreword to the Second Edition

5 Foreword (from first edition)

6 List of Contributors

7 SECTION 1: Late effects concepts CHAPTER 1: Introduction to long‐term survivorship after hematopoietic cell transplantation Background Rapidly rising numbers of long‐term transplant survivors Long‐term issues in long‐term survivors Developing resources and a guide for long‐term survivors Declaration of commercial interest References CHAPTER 2: International Blood and Marrow Registries: trends on long‐term data collection Overview of the Role of Registries in HCT Overview of Late Effects Data Collection through Registries Future of Data Collection in Survivorship Center for International Blood and Marrow Transplant Research (CIBMTR) The Registry of the European Society for Blood and Marrow Transplantation (EBMT) Future plans Asia‐Pacific Blood and Marrow Transplant Group (APBMT) The Registry of the Eastern Mediterranean Blood and Marrow Transplantation Group (EMBMT) References CHAPTER 3: Long‐term follow‐up program and transplant clinic setup Introduction Concept of long‐term survivorship Late effects after HSCT Timing and transition to long‐term survivorship care The transition from pediatric to adult long‐term care Long‐term follow‐up program Long‐term follow‐up Clinic Long‐term transplant team and the annual LTFU visit Recommendation for screening and preventive practices Organizing a long‐term follow‐up clinic in resource‐limited countries References CHAPTER 4: Telemedicine in patient care of long‐term transplant survivors Introduction Principles of telehealth What we know about current models for hct survivorship Example of a LTFU telemedicine model Future directions References CHAPTER 5: Long‐term follow‐up calendar Introduction Survivorship care plan Schedule of the long‐term follow‐up visit Screening and preventive recommendations References CHAPTER 6: Late effects post‐allogeneic hematopoietic stem cell transplantation Introduction Identification of late effects Late effects Very late effects Future directions Summary References CHAPTER 7: Late effects post‐autologous hematopoietic stem cell transplantation Introduction Pulmonary Complications Cardiovascular Complications Secondary Malignancies Endocrine and Metabolic Complications Kidney Complications Infectious Complications Quality of Life and Psychosocial Effects Cognitive Dysfunction Special Considerations in Lymphoma and Myeloma Conclusion References CHAPTER 8: Long‐term follow‐up of children Introduction Common posttransplant screening and prevention guidelines Survivorship care plans References CHAPTER 9: Graft‐versus‐host disease and late effects after hematopoietic stem cell transplantation Introduction cGVHD and nonmalignant late effects Secondary Malignancies References CHAPTER 10: Screening and prevention guidelines for hematopoietic cell transplant survivors Introduction Published guidelines for screening and prevention of late complications in hsct survivors Non‐infectious late effects Infectious and immunologic Subsequent neoplasms Treatment summary and survivorship care plans Areas for future research References CHAPTER 11: Biology of survivorship after blood or marrow transplantation Introduction Anthracycline‐related heart failure Therapy‐related myeloid neoplasia Cognitive outcomes Conclusions References

8 SECTION 2: Specific late effects CHAPTER 12: Second malignancies Introduction Estimating the risk of second cancers Pathophysiology Risk factors for secondary malignancies Diagnosis, screening and prevention Management; Treatment and Recommendations References CHAPTER 13: Anti‐infective prophylaxis, immunization and prevention of late infectious complications Introduction Vaccination Prevention of bacterial infections Prevention of viral infections Prevention of fungal infections References CHAPTER 14: Seasonal respiratory viral infections Introduction Community Respiratory Virus Infections in HCT Recipients Respiratory viruses and alloimmune lung syndrome Diagnostic Evaluation Treatment Options Preventing exposure Preventing Disease and Progression to LRTI Future Considerations References CHAPTER 15: Monitoring and management of hepatitis B, C, and HIV infection before and after transplantation Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) Human Immunodeficiency Virus (HIV) Acknowledgment References CHAPTER 16: Skin chronic GVHD Introduction cGVHD pathophyisiology Pathological findings in cutaneous cGVHD Clinical manifestations Clinical management Imaging and instrumental tools in skin cGVHD Systemic treatment Ancillary and topical treatment References CHAPTER 17: Ocular complications Introduction Ocular graft‐versus‐host disease Cataract formation Other non‐GVHD ocular complications Recommendations for the survivors / general practitioner References CHAPTER 18: Management of oral and dental complications Introduction Xerostomia and salivary gland hypofunction Oral graft‐versus‐host disease Jaw/bisphosphonate osteonecrosis Secondary malignancies Conclusions References CHAPTER 19: Thyroid disease: monitoring and management guidelines Introduction Hypothyroidism Hyperthyroidism Thyroid nodules Thyroid disorders and pregnancy post‐HSCT References CHAPTER 20: Pretransplant considerations in gender, reproductive, and sexual health Introduction Summary References CHAPTER 21: Posttransplant Considerations in Gender, Reproductive, and Sexual Health Introduction Genital chronic graft‐versus‐host disease Summary References CHAPTER 22: Fertility issues, fertility preservation, and pregnancy outcome in long‐term survivors Female fertility after HSCT Male fertility after HSCT Pregnancy after HSCT Maternal health during pregnancy following HSCT Fertility Prevention Counseling References CHAPTER 23: Sexual Dysfunction in Long‐Term Survivors Introduction Sexual Well‐Being and Sexual Distress Sexual Dysfunction Risk Factors Screening and Prevention Treatment Considerations for Sexual Minority Populations Recommendations for Practitioners Regarding SM Patients Recommendations for Practitioners Recommendations for Survivors References CHAPTER 24: Late non‐infectious pulmonary complications Introduction Early Non‐infectious Pulmonary Complications Posttransplant Lymphoproliferative Disorder (PTLD) Diagnostic considerations of non‐infectious pulmonary complications following HSCT Conclusion References CHAPTER 25: Cardiac and arterial complications Late cardiac dysfunction Arterial disease Disclosures References CHAPTER 26: Cardiovascular risk factors Introduction Dyslipidemia Hypertension Diabetes Other Endocrinopathies Metabolic syndrome Summary References CHAPTER 27: Gastrointestinal complications Introduction Pre‐existing gastrointestinal conditions Preconditioning‐related GI complications Acute and subacute complications Chronic complications Future directions Financial support Disclosures References CHAPTER 28: Hepatic Complications Introduction Initial evaluation Iron overload Chronic hepatic graft‐versus‐host disease (GVHD) Chronic hepatitis B (HBV) Chronic hepatitis C (HCV) Chronic hepatitis E (HEV) Non‐alcoholic fatty liver disease (NAFLD) Focal nodular hyperplasia (FNH) Nodular regenerative hyperplasia (NRH) Cirrhosis Hepatocellular carcinoma (HCC) References CHAPTER 29: Renal complications Introduction Acute kidney injury Chronic kidney disease Pathophysiology Thrombotic microangiopathy Proteinuria Podocytopathy Bk nephropathy End stage renal disease Strategies to prevent and mitigate kidney injury post HSCT References CHAPTER 30: Posttransplantation bone disease: prevalence, surveillance, prevention, and management Introduction Low Bone Mineral Density, Osteopenia and Osteoporosis Frequency/Cumulative Incidence Risk Factors Surveillance/Screening

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