Late Complications After Allogeneic Hematopoietic Stem Cell Transplantation

Objective: To anlyze the incidence of chronic graft-versus-host disease (cGVHD)and late-onset complications after allogeneic hematopoietic stem cell transplantationand to explore whether cGVHD is the risk factor of late-onset complicationsfollowing allogeneic hematopoietic stem cell transplantation (allo-HSCT).Method: We retrospectively analyzed the clinical data of174patients whounderwent allo-HSCT in our BMT unit from September,1997to July2011. Thepatients who survived at least100days from transplantation with successfulengraftment and without relapse were included into this study. The incidence and riskfactors of the long-term complications after allo-HSCT (ocular, pulmonary, kidney,heart, muscle and bone complicationts, and secondary tumors and mental problems)were analyzed. Risk factors were assessed by Logistic univariate and multivariatestatistical regression models or Chi-square test. The follow-up ended on March1,2012.Result:174cases were enrolled in this study and the total incidence of long-termcomplications was56.9%.19of174patients developed LONIPCs (10.9%); Nephroticsyndrome occurred in6of174patients (3.4%); Cardiomyopathy in2cases (1.1%);keratoconjunctivitis sicca syndrome in50cases (28.7%); blind in2case caused bycorneal rupture (2.9%); cataract in5cases (2.9%); Avascular necrosis of femoralhead in3cases (1.7%); deformity of spinal column in3cases (1.7%); joint andmuscle stiffness caused by sclerodema in3cases (1.7%); myasthenia gravis in1case(0.5%); secondary tumors in4case, including2cases of PTLD (post-transplantlymphoproliferative disease) of2case (1.1%) and2cases of solid tumors of (1.1%).Three patients developed psychological disorder.Logistic multivariate analysis showed that transplants from an unrelated donorand occurrence of extensive chronic GVHD were significantly associated with thedevelopment of LONIPCs. Chi-square test showed that the development ofKeratoconjunctivitis sicca syndrome was significantly associated with the occurrence of extensive chronic GVHD (P=0.00). Five of six cases of nephrotic syndromedeveloped cGVHD. Sclerodema, the cause of joint and muscle stiffness, andmyasthenia gravis were directly related with cGVHD, particularly extensive cGVHD.Cataract, avascular necrosis of femoral head and deformity of spinal column(osteoporosis) were attributed to lengthy exposure to steroid treatment of cGVHD.Cardiomyopathy was closely associated with the use of overdose of anthracyclinespre-transplantation. It is likely that secondary tumors are mainly related to immunedeficiency post transplantation.Conclusion: The late-onset complications would involve many organs afterallogeneic hematopoietic stem cell transplantation, affecting the quality of life (QOL).They largely would be related to cGVHD or immunosuppressive therapy, andtherefore, the prevention and treatment of cGVHD would be helpful to reducelate-onset complications.