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BMTCN REVIEW CHAPTER 3 - PRETRANSPLANT ISSUES WITH COMPLETE SOLUTIONS
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BMTCN REVIEW CHAPTER 3 - PRETRANSPLANT ISSUES WITH COMPLETE SOLUTIONS
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BMTCN REVIEW CHAPTER 7 -SURVIVORSHIP ISSUES WITH
COMPLETE SOLUTIONS
Survivors and Survivorship - answer An individual is considered a cancer survivor from the time
of diagnosis through the balance of his/her life
Survivorship is a distinct phase of the cancer experience
Some patients do not embrace the term "cancer survivor"
Some definitions acknowledge the impact of cancer survivorship on families, friends and
caregivers
HSCT Survivorship - answer Number is increasing
-Improvements in outcomes
-Expanding indications for transplant
-Treatment of older patients with reduced-intensity conditioning
Increased number of available donors
Approximately 250,000 HSCT survivors are more than 5 years post-HSCT
Pediatric HSCT survivors - answer Face unity challenges
-Growth and development
-Cognitive development
-School re-entry
,Secondary Malignancies - answer Receiving chemotherapy associated with secondary
malignancies
-Auto HSCt survivors - 12 fold increased risk
-Allo HSCT survivors - 3.5 fold increased risk
Three distinct groups of secondary malignancies
-MDS and AML
-PTLD's
-Second solid malignancies
Therapy related MDS and AML - 5%-15% of auto HSCT
-Usually within 2 - 5 years
-Rare in the allo HSCT setting
-Refer to page 202 for specifics
Post auto HSCT t-MDS - poor prognosis.
-Median survival 6 months
Secondary Malignancies: Incidence - answer PTLD is the most common second malignancy in
the first year after allo HSCT using a T-cell-depleted graft
Survivors > 15 years post allo HSCT have a 3-fold risk of developing a solid malignancy compared
to the general population
Secondary Malignancies: Risk factors - PTLD - answer Characteristics of the graft
Preparative regimen or agents for GVHD
, Primary immunodeficiency; acute or extensive cGVHD; or Epstein-Barr virus (EBV)
Secondary Malignancies: Causes - answer Alkylating agents, topoisomerase inhibitors
Radiation
Secondary Malignancies: Risk factors - Solid Tumor - answer Younger age, TBI, chronic GVHD,
genetic predisposition, increasing time from HSCT, infection, lifestyle factors (smoking, sun)
(pg. 234)
Secondary Malignancies: Screening - answer Should begin 12 months post-HSCT and then
annually
Colonoscopies begin age 50 (at age 35 for pediatric survivors who received >30 Gy of radiation
to abdomen, pelvis or spine)
Mammogram screening in women who received XRT should begin at age 25 or 8 years after
exposure but no later than age 40
Pap smears every 1-3 years in women > age 21 or within 3 years of becoming sexually active
EBV titers should be monitored for at least 6 months after allo HSCT for patients at high risk of
PTLD
Secondary Malignancies: Health Maintenance and Counseling - answer Review risks
Perform self examinations (breast, skin, testicles, oral cavity)
Meticulous oral hygiene
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