فارسی
In most cases, organ damage may occur following the administration of drugs used in chemotherapy and the preparation regimen for hematopoietic stem cell transplantation, total body radiotherapy (TBI), and chronic graft-versus-host disease (GVHD).
These injuries are temporary and reversible and in few cases can be life threatening. One study showed that the incidence of any organ damage at five years after hematopoietic stem cell transplantation (HSCT) was 45% among autologous recipients and 79% among allogeneic recipients, and 2.5% among autologous recipients and 26 % of allogeneic recipients had three or more organ injuries.
The following organ injuries are the most common of these injuries, which do not include rare types; It should be noted that these injuries have different forms and intensities depending on the person’s body and the type of treatment, and the patient may not experience all of these possible problems at the same time or none at all.
– One of the most common organ damage is oral and dental problems, which can occur after total body irradiation or chronic GVHD. These problems include inflammation and scarring of the mucous membrane, changes in taste, dry mouth, decay, loosening or loss of teeth and abnormal growth of teeth, or bone necrosis that occurs after high-dose radiotherapy. Annual dental examination is necessary to diagnose and treat these problems.
– Among other common organ injuries are vision problems, especially cataracts, which can be treated with an outpatient surgery. In the case of (GVHD) after transplantation, there is a possibility of dry eyes and other vision problems.
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Organ failure: Bone problems including:
- Osteoporosis, which sometimes occurs after transplantation, is more common in women and people who are old, menopausal, or have been treated with steroids.
Following the prescription of exercise, calcium, vitamin D, estrogen replacement therapy and bisphosphonate, the treatment is done.
- Loss of blood flow to bone (avascular necrosis), which is more common in people who are older, receiving total body radiotherapy, have aplastic anemia or leukemia, have been treated with steroids following GVHD.Avascular necrosis occurs in 5% to 20% of allogeneic (donor) transplant patients and most commonly affects the hip or knee.Treatment measures include exercise in mild cases or joint replacement surgery in more severe cases.
– An underactive thyroid has symptoms including weight gain, hair loss, dry skin, sensitivity to cold, fatigue and constipation, and growth disorders in children. Oral thyroid hormones are usually prescribed to treat this problem.
– Obstructive bronchitis is seen only in patients who had an allogeneic transplant and reduces airflow through the lungs. Risk factors include: history of GVHD, history of respiratory viral infections after transplantation, respiratory problems before transplantation and older age. Symptoms include: dry cough, shortness of breath, wheezing.
Obstructive bronchitis is very difficult to treat. The best treatment results are seen in patients who start treatment early in their disease course, although 20% of patients have no symptoms in the early stages of the disease.
– Heart problems that are three times more common for patients who have had an allogeneic transplant than the general population. Prescribing exercise, a healthy diet, controlling blood cholesterol, blood pressure, and blood glucose levels can reduce the risk of heart disease.
– Organ failure following HSCT,Liver problems:
- One of the common problems is iron overload, which occurs in some patients who have received a lot of blood before or during a transplant.such as patients with myelodysplastic syndrome (MDS), severe aplastic anemia, thalassemia, and sickle cell disease.This condition may lead to an increased risk of infection, or a negative impact on liver and heart health.This problem is usually treated by draining some of the blood through a process called phlebotomy, which is similar to the process of donating blood.
- Hepatic venous occlusive disease (VOD) is a rare but very serious and life-threatening problem in which the blood vessels inside the liver become blocked.This problem only occurs in people who have an allogeneic transplant and more often in people who received the drugs busulfan or melphalan before the transplant, elderly people who had liver problems before the transplant, and people with GVHD.
Yellowing of the skin and eyes, dark urine, tenderness under the ribs where the liver is located, and rapid weight gain due to the accumulation of fluid that causes abdominal bloating are some of the early signs of this condition. Early detection of VOD is very important.
– Kidney problems are at greatest risk in patients who have multiple myeloma, have undergone TBI, or have chronic GVHD. The treatment of kidney disease is different depending on the type of kidney problem and requires the appropriate treatment. Sometimes herbal supplements are effective in treating this condition.
– Neurological complications such as seizures, headaches, mental and consciousness disorders, cerebellar symptoms and cognitive deficits have been reported in patients who received HSCT, which are usually attributed to allogeneic transplantation, previous underlying disease, drug and radiation toxicity, or infection. But it seems that GVHD has the biggest contribution in front of the mentioned confounding factors in causing these complications.
Author and translator: Dr. Maryam Mehravar
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