Summary: After a pediatric bone marrow transplant, patients are at risk of developing new transplant-related health problems. These problems may not appear until later in life. This presentation discusses the potential complications, available treatments, and the importance of a healthy lifestyle ongoing monitoring to detect health issues early, when treatment is most effective.
Presenter: Robert Krance MD, Texas Children’s Hospital
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Highlights:
Total body irradiation and some chemotherapy drugs can make young boys sterile. Males transplanted after puberty may retain fertility. Young girls may retain fertility if transplanted before puberty, but fertility is almost always lost if they are transplanted after puberty.
The risk of other cancers after transplant is roughly double that of the general population and this risk increases over time. Since these cancers may not appear for 10 years or more post-transplant, annual exams and regular screenings are important throughout one’s life.
Maintaining a regular exercise program can minimize the risk of many post-transplant complications. Pediatric patients should have a long-term health plan and transplant centers should help with this. Healthy lifestyle habits and behaviors are also important to maintain.
May 3, 2022 Part of the Virtual Celebrating a Second Chance at Life Symposium 2022
Presentation is 39 minutes long with 16 minutes of Q & A.
Key Points:
(04:40): Getting re-immunized after transplant is extremely important.
(09:15): The incidence of heart disease in transplant survivors is ten times greater than seen in the general population
(13:05): Bone problems like osteoporosis or osteopenia occurs in a quarter of patients post-transplant.
(13:57): Kidney injury is common after transplant. It can be subtle and may not show up early on typical kidney tests for BUN and creatinine.
(16:14): Monitoring to catch lung injury early is crucial, because it is difficult to treat, once it becomes severe.
(17:59): Patients should be monitored regularly for skin graft-versus-host disease and skin cancer.
(20:06): Hormone failure can delay or inhibit growth in young patients.
(27:08): The liver is sensitive to drugs and irradiation and at risk for excess iron which may be treated through phlebotomy.
(29:11): Metabolic syndrome can develop after transplant and increase the risk of diabetes, stroke and cardiac disease.
(34:10): Young transplant patients who have received radiation should have regular neurocognitive testing, although most data suggest they will maintain average IQ and cognitive performance.
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