National cancer institute-national heart, lung and blood institute/pediatric blood and marrow transplant consortium first international consensus conference on late effects after pediatric hematopoietic cell transplantation: Long-term organ damage and dysfunction

Michael L. Nieder, George B. McDonald, Aiko Kida, Sangeeta Hingorani, Saro H. Armenian, Kenneth R Cooke, Michael A. Pulsipher, K. Scott Baker

Research output: Contribution to journalArticle

Abstract

Long-term complications after hematopoietic cell transplantation (HCT) have been studied in detail. Although virtually every organ system can be adversely affected after HCT, the underlying pathophysiology of these late effects remain incompletely understood. This article describes our current understanding of the pathophysiology of late effects involving the gastrointestinal, renal, cardiac, and pulmonary systems, and discusses post-HCT metabolic syndrome studies. Underlying diseases, pretransplantation exposures, transplantation conditioning regimens, graft-versus-host disease, and other treatments contribute to these problems. Because organ systems are interdependent, long-term complications with similar pathophysiologic mechanisms often involve multiple organ systems. Current data suggest that post-HCT organ complications result from cellular damage that leads to a cascade of complex events. The interplay between inflammatory processes and dysregulated cellular repair likely contributes to end-organ fibrosis and dysfunction. Although many long-term problems cannot be prevented, appropriate monitoring can enable detection and organ-preserving medical management at earlier stages. Current management strategies are aimed at minimizing symptoms and optimizing function. There remain significant gaps in our knowledge of the pathophysiology of therapy-related organ toxicities disease after HCT. These gaps can be addressed by closely examining disease biology and identifying those patients at greatest risk for adverse outcomes. In addition, strategies are needed for targeted disease prevention and health promotion efforts for individuals deemed at high risk because of their genetic makeup or specific exposure profile.

Original languageEnglish (US)
Pages (from-to)1573-1584
Number of pages12
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Volume17
Issue number11
DOIs
StatePublished - Nov 2011
Externally publishedYes

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National Heart, Lung, and Blood Institute (U.S.)
National Cancer Institute (U.S.)
Cell Transplantation
Bone Marrow
Pediatrics
Transplants
Transplantation Conditioning
Graft vs Host Disease
Health Promotion
Fibrosis
Kidney
Lung
Therapeutics

Keywords

  • Cardiac toxicity
  • Pediatric allogeneic transplantation
  • Pediatric autologous transplantation
  • Pulmonary toxicity
  • Renal toxicity

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

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title = "National cancer institute-national heart, lung and blood institute/pediatric blood and marrow transplant consortium first international consensus conference on late effects after pediatric hematopoietic cell transplantation: Long-term organ damage and dysfunction",
abstract = "Long-term complications after hematopoietic cell transplantation (HCT) have been studied in detail. Although virtually every organ system can be adversely affected after HCT, the underlying pathophysiology of these late effects remain incompletely understood. This article describes our current understanding of the pathophysiology of late effects involving the gastrointestinal, renal, cardiac, and pulmonary systems, and discusses post-HCT metabolic syndrome studies. Underlying diseases, pretransplantation exposures, transplantation conditioning regimens, graft-versus-host disease, and other treatments contribute to these problems. Because organ systems are interdependent, long-term complications with similar pathophysiologic mechanisms often involve multiple organ systems. Current data suggest that post-HCT organ complications result from cellular damage that leads to a cascade of complex events. The interplay between inflammatory processes and dysregulated cellular repair likely contributes to end-organ fibrosis and dysfunction. Although many long-term problems cannot be prevented, appropriate monitoring can enable detection and organ-preserving medical management at earlier stages. Current management strategies are aimed at minimizing symptoms and optimizing function. There remain significant gaps in our knowledge of the pathophysiology of therapy-related organ toxicities disease after HCT. These gaps can be addressed by closely examining disease biology and identifying those patients at greatest risk for adverse outcomes. In addition, strategies are needed for targeted disease prevention and health promotion efforts for individuals deemed at high risk because of their genetic makeup or specific exposure profile.",
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author = "Nieder, {Michael L.} and McDonald, {George B.} and Aiko Kida and Sangeeta Hingorani and Armenian, {Saro H.} and Cooke, {Kenneth R} and Pulsipher, {Michael A.} and Baker, {K. Scott}",
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T1 - National cancer institute-national heart, lung and blood institute/pediatric blood and marrow transplant consortium first international consensus conference on late effects after pediatric hematopoietic cell transplantation

T2 - Long-term organ damage and dysfunction

AU - Nieder, Michael L.

AU - McDonald, George B.

AU - Kida, Aiko

AU - Hingorani, Sangeeta

AU - Armenian, Saro H.

AU - Cooke, Kenneth R

AU - Pulsipher, Michael A.

AU - Baker, K. Scott

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AB - Long-term complications after hematopoietic cell transplantation (HCT) have been studied in detail. Although virtually every organ system can be adversely affected after HCT, the underlying pathophysiology of these late effects remain incompletely understood. This article describes our current understanding of the pathophysiology of late effects involving the gastrointestinal, renal, cardiac, and pulmonary systems, and discusses post-HCT metabolic syndrome studies. Underlying diseases, pretransplantation exposures, transplantation conditioning regimens, graft-versus-host disease, and other treatments contribute to these problems. Because organ systems are interdependent, long-term complications with similar pathophysiologic mechanisms often involve multiple organ systems. Current data suggest that post-HCT organ complications result from cellular damage that leads to a cascade of complex events. The interplay between inflammatory processes and dysregulated cellular repair likely contributes to end-organ fibrosis and dysfunction. Although many long-term problems cannot be prevented, appropriate monitoring can enable detection and organ-preserving medical management at earlier stages. Current management strategies are aimed at minimizing symptoms and optimizing function. There remain significant gaps in our knowledge of the pathophysiology of therapy-related organ toxicities disease after HCT. These gaps can be addressed by closely examining disease biology and identifying those patients at greatest risk for adverse outcomes. In addition, strategies are needed for targeted disease prevention and health promotion efforts for individuals deemed at high risk because of their genetic makeup or specific exposure profile.

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KW - Pediatric autologous transplantation

KW - Pulmonary toxicity

KW - Renal toxicity

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