In the first year (especially the first 6 months) after transplantation, many transplant recipients are affected by side effects or complications of the treatment. When this "critical phase" over, it is possible to gradually return to a virtually normal Daily life Build up and enjoy the finer things in life. However, one should not assume that one is completely healthy and "bursting with vigor". Conditioning therapy, previous pre-treatments and the disease itself are a strain on the body from which it must slowly recover. Some changes in the body are permanent. As a result, there are a few things to keep in mind for the long term.
In the KMT Outpatient Clinic you will generally only be examined monthly and later annually as long as your health is stable.
Novartis
Average survival rate in the first 7 years after allogeneic PBSZT (all diseases and conditioning therapies combined) in a Seattle clinic (mod. according to [3])
Life expectancy
More and more patients are surviving longer and longer after allogeneic blood stem cell transplantation. This is mainly due to the fact that in recent decades transplantation has become increasingly more secure has become. The so-called transplant-associated mortality (mortality) has continuously decreased. Possible causes of death caused by the transplantation are mainly GvHD, infections and organ damage.
The most common single cause of death, however, is the underlying disease itself (relapse or progression of the cancer).
Both the risk of relapse and the risk of dying from a complication are highest in the first year after transplantation and then usually decrease steadily (s. Figure 2).
Unfortunately, it is therefore not possible to say across the board that transplant recipients gain a certain number of years of life through allogeneic blood stem cell transplantation. The Forecast varies greatly from individual to individual and depends z. B. From [1]:
- the nature of the disease,
- the stage of the disease,
- the age and physical condition of the patient, and
- the degree of matching of HLA characteristics of donor and patient
Desire to have children
For most adults who are over 25 years of age, the "full" conditioning therapy to a Permanent infertility (sterility). For women, this means that they enter menopause prematurely. However, of the women who were younger than 25 when they had the transplant, 10 to 20% may become pregnant again after 5 to 10 years [2].
The effects of a dose-reduced conditioning therapy effects on fertility are not yet sufficiently researched. They depend on which drugs are used and how high the radiation dose is.
Regardless of the type of conditioning, since it is not possible to assume 100% sterility in every case, a Contraception useful [2].
If there is a pregnancy comes, there is an increased risk of a miscarriage. The risk of malformation is not increased for delivered children [2].
Travel
As long as one still has to take immunosuppressants and the usual vaccinations have not been refreshed, one should only travel to areas with high hygienic standards. If the health condition is not (yet) stable, it is also recommended not to move too far from the transplant center. It is best to always discuss travel plans with the transplant center or the patient’s doctor. to be discussed with the KMT outpatient clinic.
Reduce health risks
Conditioning therapy and some immunosuppressants increase the risk of developing certain cancers. By leading a healthy lifestyle, you can help to avoid an additional increase in the risk of cancer. For example
- to give up smoking completely.
- Ensuring adequate sun protection.
New blood group
If the donor of the blood stem cells has a different blood type than the recipient, the recipient will receive the donor’s blood type after the transplantation. Sometimes having two blood types at the same time for a transition while "old" ones are still available own stem cells remain in the bone marrow and form blood cells. A new blood group card can be obtained from the transplant center.
Possible long-term complications after allogeneic hematopoietic stem cell transplantation (PBSZT)
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Among the more common possible long-term complications after an allogeneic blood stem cell transplantation:
- Chronic GvHD
- Osteoporosis and aseptic bone necrosis with long-term treatment with cortisone
- Recurrence (relapse, return) of the original disease
- Chronic tendency to infection
- Second tumors
- Cataract (clouding of the eye lens) after radiotherapy
- hypothyroidism after radiotherapy
The chronic form of GvHD Occurs in up to 50% of transplant recipients, but is more common in mild forms. Often needs to be treated with corticosteroids (cortisone) for 2 years or more. These drugs can in turn lead to side effects. For example, bone density may decrease (osteoporosis), so that one becomes more susceptible to bone fractures. In 5 to 10 % of patients treated with cortisone, a Aseptic bone necrosis, d. h. Bone tissue dies. Necrosis usually affects the hip or knee joint. The dead tissue is removed in an operation and usually replaced by an artificial joint.
The risk for a Recurrence (relapse) of the original disease varies greatly from individual to individual. It depends on the type of disease and how far the disease had progressed before the transplantation (stage). This is how z. B. in case of aplastic anemia almost never relapse. However, those leukemias and lymphomas for which previous treatments were ineffective return in up to more than 50% of transplant recipients after transplantation. Often, donor lymphocytes are then administered, which attack the cancer cells (graft-versus-leukemia effect). In some cases a second blood stem cell transplantation is useful.
The risk of contracting infections may remain elevated over time.
Because of the intensive treatment with radiation and/or chemotherapy, the risk is increased of developing a second cancer to develop. After 10 to 20 years, about 2 to 3 % of transplanted patients develop a tumor, which usually appears on the skin or mucous membranes. If detected in time, these tumors can often be cured. Therefore the regular control examinations are important lifelong. Rarely do tumors occur in the brain, thyroid or bone.
One cataract (clouding of the eye lens) develop ca. 20 to 25 % of patients 5 to 10 years after total body irradiation. It can be fixed by outpatient surgery.
Another possible complication after total body irradiation is a Underactivity of the thyroid gland. It occurs in 10 to 15% of patients and can be compensated by medication (thyroid hormones).