Survivorship Issues: Practices, Guidelines and Controversies
As advancements in hematopoietic cell transplant decrease early transplant-related mortality, the number of longer-term survivors of transplant fortunately increases. This growing patient population has distinct healthcare and economic issues that are ste
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Shahrukh Khurshid Hashmi and Minoo Battiwalla
15.1 Introduction Significant advancements in hematopoietic cell transplant (HCT) have greatly improved early transplant-related mortality (TRM) and broadened the applicability of this potentially curative treatment modality. And due to this success, there is increasing awareness within the transplant community (but not by the general medical community) of unique survivorship issues, which can culminate in significant morbidity and mortality in HCT survivors. Many “late complications” which are also known as “late effects”, or “transplant complications” in the literature occur with a wide spectrum in terms of intensity, latency, and mortality. For simplicity, we would use the term late effects for all transplant- (and those related to pre-transplant chemotherapy, radiation, or transfusions) related morbidities. For practicing clinicians whether they would be in the field of hematology, oncology, hospital medicine, pediatrics, or primary care, there is an essential need to understand the pathology, management, and preventative strategies in order to deliver optimum care to the HCT survivors. Herein, we mention the current advances and certain key controversies relevant to survivorship issues, and then portray the future directions of survivorship care.
S. K. Hashmi (*) King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia Mayo Clinic, Rochester, MN, USA e-mail: [email protected] M. Battiwalla National Institutes of Health, Bethesda, MD, USA e-mail: [email protected] © Springer Nature Switzerland AG 2020 L. Finn, A. R. Roche Green (eds.), Supportive Care Strategies, Advances and Controversies in Hematopoietic Transplantation and Cell Therapy, https://doi.org/10.1007/978-3-319-59014-1_15
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S. K. Hashmi and M. Battiwalla
15.2 What Is HCT Survivorship and Why Is It Essential? Experts have defined cancer survivorship as the life beyond active treatments for the cancer; however, it starts at cancer diagnosis. Recently the National Institutes of Health (NIH) Late Effects Initiative have dealt with issues revolving around HCT survivorship and have defined it in the broad context of preventative strategies as well as psychosocial and physical issues complications starting after 1 year of HCT (Battiwalla et al. 2017). Practically, survivorship issues can start at any time after the first few months of HCT, especially in cases of autologous HCT (auto-HCT) since the confounding factor of survivorship issues with the graft-versus-host- disease is absent in the cases of auto-HCT. The issue of relapse of the original indication for HCT is the main barrier to successful survivorship; however, this mainly applies to malignant conditions. This field of HCT survivorship is currently in its infancy; however, just over the past decade, a tremendous momentum has been observed in this field’s activity as indicated by increasing publications, grants and presentations/sessions at the national HCT-related meetings. More than 65,000 HCTs are occ
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