Library of Congress Cataloging‐in‐Publication Data
Names: Savani, Bipin N., editor. | Tichelli, André, editor.
Title: Blood and marrow transplantation long term management : survivorship after transplant / edited by Bipin N Savani, André Tichelli.
Description: Second edition. | Hoboken, NJ : Wiley‐Blackwell, 2021. | Includes bibliographical references and index.
Identifiers: LCCN 2020053132 (print) | LCCN 2020053133 (ebook) | ISBN 9781119612698 (hardback) | ISBN 9781119612742 (adobe pdf) | ISBN 9781119612735 (epub)
Subjects: MESH: Hematopoietic Stem Cell Transplantation–adverse effects | Long Term Adverse Effects–prevention & control | Disease‐Free Survival | Survivors
Classification: LCC RD123.5 (print) | LCC RD123.5 (ebook) | NLM WH 380 | DDC 617.4/410592–dc23
LC record available at https://lccn.loc.gov/2020053132 LC ebook record available at https://lccn.loc.gov/2020053133
Cover Design: Wiley
Cover Image: Bipin N. Savani and André Tichelle
Foreword to the Second Edition
by Professor John Barrett
Since 2013 when the publication of the first edition of Savani’s Blood and Marrow Transplantation Long Term Management: Prevention and Complications the accelerated pace of stem cell transplant activity worldwide since the beginning of this century, together with the continuing trend to reduced early mortality from the procedure has translated into an almost exponential expansion in the number of long term survivors which must now number well beyond half a million individuals surviving more than five years. More than ever, to serve our patients we need this authoritative guide for the management of our long‐term survivors as well as a comprehensive and contemporaneous account of the causative factors of long‐term complications that can inform us of better ways to do stem cell transplants.
What have we learned in the last few years? Chronic graft‐versus‐host disease (C‐GVHD) is increasingly recognized as a cause of late effects not hitherto ascribed to this common post‐transplant event. It is now clear that human papilloma virus (HPV) contributes to a significant proportion of the second malignancies which relentlessly increase over time after transplant. Understanding the impact of these two risk factors is important in focusing efforts to avoid C‐GVHD, and by using post‐transplant HPV vaccination to reduce second malignancies. As observational studies of long‐term survivors accumulate, we are discovering new late effects extending beyond the familiar territories of GVHD and second tumors. In this newest edition, the section of organ‐specific late effects is greatly expanded. In particular delayed cardiovascular events are being defined, as well as a much clearer idea of the psychosocial and economic burden that long‐term survivors and their carers may experience. Finally, we are beginning to distinguish different trajectories of late effects due to particular transplant approaches. Over and above the well characterized differences on late outcomes after autologous versus allogeneic SCT databases are extensive enough to identify the impact of different and newer transplant approaches for example haplo‐identical donor transplants.
All this new information and increased competence in managing as well as preventing transplant late effects could not have been possible without a concerted effort from all the major transplant registries and societies to concentrate on the problem. This has led to the development of useful guidelines, dedicated multidisciplinary late effect clinics, and a gratifyingly broader knowledge base among transplant physicians and primary caregivers, which in turn leads to better patient management. The first section of this book captures the contribution by the world’s registries as well as provides a helpful guide to establishing a comprehensive long‐term follow‐up program including the application of telemedicine to this discipline.
The editors Dr. Bipin Savani and Dr. Andre Tichelli are pioneers in the field of transplant late effects and they have selected contributing authors from a worldwide elite of experts in late effects of transplantation. They have amply addressed all the new advances in biology and prevention of late effects and have authoritatively covered all aspects of management of the long‐term transplant survivor. This book should stand as the definitive and most current text on late effects following stem cell transplantation, a field that is now an established specialty in its own right.
John Barrett
Foreword (from first edition)
by Professor John Goldman (1938–2013)
Though sadly, there has been little progress in recent years in some areas of medicine, the clinical use of hematopoietic stem cell transplantation is not one of them. If 50 years ago, one had suggested to an experienced hematologist that one could collect nucleated cells from the marrow or indeed from the blood of normal persons and infuse them in relatively small numbers into a suitably “prepared” patient with leukemia or another hematologic or immunologic disorder and thereby cure the disease, the suggestion would have been greeted with incredulity. In reality, the pioneering preclinical work of many laboratory scientists, the increased understanding of histocompatibility antigen, and the dedicated commitment of clinicians such as Georges Mathé, Robert Good, and Don Thomas laid the foundations for the first successful bone marrow transplant in the 1970s. It is difficult today to appreciate the scepticism or, indeed, formal opposition with which the initial work of these enthusiasts was met.
In the beginning of the 21st century, stem cell transplantation in some form or another is practised in 60 to 70 countries of the world and there is no aspiring hematologist who does not learn early that there are certain diseases for which allogenic or autologous stem cell transplantation offers a real chance of cure or, at worst, just useful palliation. This means that the number of persons surviving and, in many cases, cured of a serious and usually life‐threatening disease has increased enormously in recent years. This collection of papers, written by experts in the field of stem cell transplantation, could not have been contemplated by earlier researchers in the field for the simple reason that the number of patients who had survived long term would have been very few. Today, clinical data on transplant recipients are carefully collected and analysed by two very valuable organizations: on a global scale by the International Center for Blood and Bone Marrow Research and by the European Group for Blood and Marrow Transplantation, which focuses mainly on Europe. Data collated by these two agencies and the multiplicity of individual publications covering many aspects of health in patients alive at 5, 10 or more years after a transplant procedure show clearly that some long‐term survivors do still have specific problems associated with their original transplant procedures, but most of these are relatively minor and eminently treatable.