Inamoto Yoshihiro, Lee Stephanie J
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Haematologica. 2017 Apr;102(4):614-625. doi: 10.3324/haematol.2016.150250. Epub 2017 Feb 23.
Hematopoietic cell transplantation is a curative treatment for a variety of hematologic diseases. Advances in transplantation technology have reduced early transplant-related mortality and expanded application of transplantation to older patients and to a wider variety of diseases. Management of late effects after transplantation is increasingly important for a growing number of long-term survivors that is estimated to be half a million worldwide. Many studies have shown that transplant survivors suffer from significant late effects that adversely affect morbidity, mortality, working status and quality of life. Late effects include diseases of the cardiovascular, pulmonary, and endocrine systems, dysfunction of the thyroid gland, gonads, liver and kidneys, infertility, iron overload, bone diseases, infection, solid cancer, and neuropsychological effects. The leading causes of late mortality include recurrent malignancy, lung diseases, infection, secondary cancers and chronic graft--host disease. The aim of this review is to facilitate better care of adult transplant survivors by summarizing accumulated evidence, new insights, and practical information about individual late effects. Further research is needed to understand the biology of late effects allowing better prevention and treatment strategies to be developed.
造血细胞移植是多种血液系统疾病的一种治愈性治疗方法。移植技术的进步降低了早期移植相关死亡率，并将移植的应用范围扩大到老年患者以及更多种类的疾病。对于全球估计达50万的越来越多的长期存活者而言，移植后远期效应的管理变得日益重要。许多研究表明，移植存活者遭受显著的远期效应，这些效应会对发病率、死亡率、工作状态和生活质量产生不利影响。远期效应包括心血管、肺和内分泌系统疾病、甲状腺、性腺、肝脏和肾脏功能障碍、不孕、铁过载、骨疾病、感染、实体癌以及神经心理效应。晚期死亡的主要原因包括复发恶性肿瘤、肺部疾病、感染、继发性癌症和慢性移植物抗宿主病。本综述的目的是通过总结关于个体远期效应的累积证据、新见解和实用信息，促进对成年移植存活者的更好护理。需要进一步研究以了解远期效应的生物学机制，从而制定更好的预防和治疗策略。
