Complications
Continued treatment for graft versus host disease leads to additional drug-induced complications. Address risk of infection, provide appropriate infection prophylaxis, monitor potential drug-drug interactions, and limit intensity of immunosuppressive therapy as clinically possible.
The risks of cancers following allogeneic hematopoietic cell transplantation (HCT) include the involvement of the skin (squamous-cell carcinoma, basal-cell carcinoma, and melanoma), oral mucosa (squamous-cell carcinoma), thyroid, bone, or connective tissue, and central nervous system. There is also an increased risk of lymphoproliferative disorders due to Epstein-Barr virus infection, generally within the first year post transplant.
One study suggests that new solid cancers develop at twice the rate post-HCT compared with the general population.[177] Appropriate monitoring, early recognition, and prompt initiation of treatment are important in successful management.
Includes immunologic dysfunction, hyperglycemia, hypertension, deconditioning, muscle wasting avascular necrosis, compression fractures, cataracts.
The clinical syndrome of GVHD can lead to a wasting or malnutrition syndrome. Referral to a dietitian/nutritionist for advice is recommended to minimize the risk of this occurring.
There is an increased risk for thyroid dysfunction, gonadal dysfunction, osteoporosis, and decreased growth rates and growth hormone deficiency following allogeneic hematopoietic cell transplantation. Corticosteroid therapy can also lead to secondary adrenal dysfunction. Monitoring, early recognition, and prompt initiation of treatment are important in successful management. Endocrine consultation is recommended.
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