Long-term survivors: an overview on late effects, sequelae and second neoplasias

A large number of haematological and oncological diseases as well as inborn errors can be cured today by stem cell transplantation. However, the chemotherapy and radiation used for the preparation of BMT can induce late effects which can be rather severe. Especially in malignant diseases the late toxicity of previous conventional therapy has an additional impact. The function of various organs can be impaired, such as the eyes, the central nervous system, the teeth, the legs, the heart, the kidneys, the liver, the endocrine functions and growth. Second neoplasias occur during various times after BMT: lymphoproliferative disease may occur during the first year, leukemias and myelodysplastic syndromes develop after several years, whereas solid tumours occur even later. The incidence of second neoplasias after BMT seems to be higher in children than in adults. Many late sequelae as well as psychological disturbances can impair the quality of life of the survivors of BMT. Paediatricians should take this fact into account when they think about stem cell transplantation in a child. This all means that a long-term observation in these persons is necessary and this is done best within a standardised follow-up programme. Meanwhile such programmes have been developed in some countries, and this should be promoted within the working party 'Paediatric Diseases' of EBMT.