Long-Term Adjustments

Abstract

Although marrow transplantation is now being carried out at several hundred centers world wide, an assessment of long-term adjustment post transplant is still preliminary. Based on the above discussions, it should be clear that long-term adjustment will depend strongly upon the patient’s underlying disease, the conditioning regimen used in preparation for marrow transplantation, and the patient’s age and social status at the time of transplantation. Patients with non-malignant diseases prepared for marrow transplantation by chemotherapy alone, in particular regimens involving only the use of cyclophosphamide, clearly do very well, return to work promptly, are productive, grow and develop normally, are in many instances fertile, andl lead essentially normal lives unless severe chronic GVHD develops. If patients suffer from a malignancy and are prepared with more aggressive conditioning, especially the use of total body irradiation, more severe delayed effects are expected. Children of both sexes show a retardation of growth, and presumably never reach their normal height. Furthermore, they are likely to have abnormal sexual development, and in most instances will be sterile. These are important factors to consider, particularly since these problems may become relevant in patients only many years after transplantation when the original trauma is almost forgotten, and is not sufficient for an explanation for problems encountered at a later point in time. This requires very sensitive and close psychological guidance. It may affect schooling of young patients, and the professional careers of adult patients who occasionally may choose a career change.