Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 60

As described above, transplant activity in developing countries has increased tremendously in this millennium, but data on the long‐term complications are scarce. There are certain differences in the HSCT practices in developing countries compared to developed countries (from Europe and North America). Specifically, indications for transplantation in the developing countries comprise of nonmalignant conditions in about half of the cases, whereas data from the US indicates that more than two‐thirds of the HSCT are done for cancers [41]. For instance, the HSCT activity for hemoglobinopathies in India, China, Pakistan and Iran has increased by six‐fold in a decade [42]. The conditioning regimens and GVHD prophylaxis used for nonmalignant conditions is very different from that for malignant conditions, thus changing the natural history of late complications in HSCT survivors [43]. The long‐term survival in HSCT recipients with malignant conditions is generally less compared to nonmalignant conditions, primarily due to increase in relapse of the cancer. Moreover, the risk of developing GVHD varies, not only due to prolonged immunosuppression used in patients with non‐malignant diseases, but also due to increased use of serotherapy for GVHD prophylaxis in the developing countries compared to the US. Due to the above‐mentioned reasons, the risks of having early mortality post‐allogeneic HSCT due to relapse or GVHD may be higher as a whole in the developed countries, however, there is no reason to believe that the risks of having late effects would be different in the developing countries compared to developed countries.

Another aspect which dictates an increased emphasis for need of formal survivorship clinics is the age spectrum of HSCT recipients. In developing countries, the population pyramid differs compared to Europe and the US, as the majority is comprised of children and the ratio of pediatric to adult HSCT is higher in the developing countries. Since the very late effects e.g. (cardiac, subsequent cancers etc.) may occur after 10 years post‐HSCT, taking care of the patients who received HSCT during their childhood is of utmost importance for surveillance and prevention of the late complications [22].