Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 49

Late mortality is increased in long‐term survivors of allogeneic HSCT when compared with an age‐ and gender‐matched general population. More than 25 years after transplantation there is still a two‐fold excess in death rate [14]. Life expectancy among 5‐year survivors after HCT is reduced by approximately 30% compared to the general population, regardless of current age or time from transplantation [15]. A variety of pre‐ and posttransplant factors can contribute to the risk of late complications. They include patient‐related factors (e.g. age, gender), lifestyle factors (smoking, physical inactivity, unhealthy diet), pretransplant co‐morbidity (particularly in elderly patients), chemotherapy and radiotherapy applied before transplantation or as conditioning regimen, and posttransplant complications (GVHD and its treatment) [16]. Some of the late complications, such as secondary malignancies and vascular complications are expected very late after HSCT. Even three decades after allogeneic HSCT, the cumulative incidence for secondary solid tumors or vascular complications continues to increase, with no indication of a plateau developing [17,18]. Other late effects appear early after HSCT but have relevant consequences on the long‐term health condition and quality of life. A typical example is bronchiolitis obliterans syndrome often occurring within the first year after allogeneic HSCT, with respiratory consequences in the long‐term. Infertility is also an early consequence of pretransplant treatment and the conditioning regimen used for HSCT. However, this complication worries survivors many years after HSCT, frequently at a time when they have overcome acute toxicity and the phase of early complications. These data demonstrate that individuals undergoing HSCT, even when cured of their primary disease, will mandatorily need a lifelong commitment for posttransplant survivorship care.