Nonmalignant late effects after allogeneic stem cell transplantation

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Abstract
Large numbers of patients now survive long term following stem cell transplantation (SCT). The late clinical effects of SCT are thus of major concern in the 21st century. Secondary malignant diseases are of particular clinical concern as more patients survive the early phase after transplantation and remain free of their original disease.1 2 These malignant complications have been previously reviewed in Blood 3 and recently updated.4 Nonmalignant late effects are heterogeneous, and although often not life threatening they significantly impair the quality of life of long-term survivors.5 The main aims of this review by the Late Effects Working Party of the European Study Group for Blood and Marrow Transplantation (EBMT) are to present physicians with an overview of these nonmalignant late complications and provide some recommendations regarding their prevention and early treatment. The major risk factors for nonmalignant complications after SCT are chronic graft-versus-host disease (cGVHD) and/or its treatment and the use of irradiation in the pretransplantation conditioning. The interrelationship between cGVHD, total body irradiation (TBI), and nonmalignant late effects are summarized in Figure 1.