Delayed complications of bone marrow transplantation: an update

To review the delayed complications of bone marrow transplantation (BMT) with respect to specific problems, prognoses, causes, times of onset, and medical and nursing management.

Books, chapters, published professional articles, computerized data bases, and proceedings of national meetings.

BMT, a life-saving measure for many patients with cancer, is associated with serious delayed complications. Morbidity and mortality from multisystem chronic graft-versus-host disease (GVHD), severe immunosuppression, sterility, growth and development problems, cataracts, relapse, secondary malignancies, and other complications can occur 100 days or more after BMT. Complications result from the effects of high-dose conditioning regimens, GVHD, transplant-related problems, and disease relapse.

BMT is a life-saving measure associated with complications that can occur months to years after transplantation. Considerable research is needed to improve treatment for these complications and to increase the length of disease-free, long-term survival.

Nurses working with patients before and after BMT can be instrumental in managing long-term complications. Preparation of patients and families prior to, during, and after BMT can help alleviate anxieties throughout the continuum of recovery. Since the population of patients who have undergone BMT is growing, nurses in community and ambulatory settings need to include evaluation for physical and psychological sequelae of BMT as part of routine assessment, and symptom management as part of standard care.