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Foreword to the Second Edition

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.

The editors Dr. Bipin Savani and Dr. Andre Tichelli are pioneers in the field of transplant late effects and they have selected contributing authors from a worldwide elite of experts in late effects of transplantation. They have amply addressed all the new advances in biology and prevention of late effects and have authoritatively covered all aspects of management of the long‐term transplant survivor. This book should stand as the definitive and most current text on late effects following stem cell transplantation, a field that is now an established specialty in its own right.

John Barrett