Skip to main content

Advertisement

SpringerLink
Log in

Long-term Effects of Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Patients with Acute Lymphoblastic Leukemia

  • Pediatric Oncology (G Tian, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Allogeneic hematopoetic stem cell transplantation (HSCT) is a curative option for children and adolescents with high-risk leukemia. Although acute complications were reduced during the last decade, considerable late effects are still limiting the overall success rate. This article emphasizes the specific pediatric aspects of long-term aftercare following myeloablative HSCT and provides an organ-based overview that covers main clinical patterns, incidence, and risk factors enhanced by current references and screening guidelines.

Recent Findings

In the last years, several attempts were made to separate pediatric outcome data from findings in adults. It turned out that not only the indication for but also the time and the procedures of HSCT substantially differ. Nearly any organ might be affected after the complex transplantation process and includes endocrinopathies, musculoskeletal disorders, cardiopulmonary complications, and secondary malignancies.

Summary

Patients after HSCT in childhood have a high risk for developing a wide range of late sequelae and may benefit from regular screening and early intervention. The occurrence and patterns of late effects depend on the intensity and severity of conditioning and are strongly associated with patient’s age at transplant and beginning of complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

RT:

radiation

TBI:

total body irradiation

cGVHD:

chronic Graft versus Host Disease

BU:

busulfan

CY:

cyclophospamide

CNI:

calcineurin inhibitors

AMH:

Anti-Müller hormone

T4:

thyroxine

TSH:

thyroid-stimulating hormone

LH:

luteinising hormone

FSH:

follicle-stimulating hormone

GI:

gastrointestinal

LFT:

lung function test

Ig:

immunoglobulins

ALL:

acute lymphatic leukemia

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bhatia S, Francisco L, Carter A, Sun CL, Baker KS, Gurney JG, et al. Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study. Blood. 2007;110(10):3784–92.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Armenian SH, Sun CL, Kawashima T, Arora M, Leisenring W, Sklar CA, et al. Long-term health-related outcomes in survivors of childhood cancer treated with HSCT versus conventional therapy: a report from the Bone Marrow Transplant Survivor Study (BMTSS) and Childhood Cancer Survivor Study (CCSS). Blood. 2011;118(5):1413–20.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Baker KS, Bresters D, Sande JE. The burden of cure: long-term side effects following hematopoietic stem cell transplantation (HSCT) in children. Pediatr Clin North Am. 2010;57(1):323–42.

    Article  PubMed  Google Scholar 

  4. Faraci M, Barra S, Cohen A, Lanino E, Grisolia F, Miano M, et al. Very late nonfatal consequences of fractionated TBI in children undergoing bone marrow transplant. Int J Radiat Oncol Biol Phys. 2005;63(5):1568–75.

    Article  PubMed  Google Scholar 

  5. Ferry C, Gemayel G, Rocha V, Labopin M, Esperou H, Robin M, et al. Long-term outcomes after allogeneic stem cell transplantation for children with hematological malignancies. Bone Marrow Transplant. 2007;40(3):219–24.

    Article  PubMed  CAS  Google Scholar 

  6. Sun CL, Francisco L, Kawashima T, Leisenring W, Robison LL, Baker KS, et al. Prevalence and predictors of chronic health conditions after hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study. Blood. 2010;116(17):3129–39. quiz 377

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Passweg JR, Baldomero H, Peters C. Hematopoietic SCT in Europe: data and trends in 2012 with special consideration of. Pediatr Transplant. 2014;49(6):744–50.

    Google Scholar 

  8. • Battiwalla M, Tichelli A, Majhail NS. Reprint of: Long-term survivorship after hematopoietic cell transplantation: roadmap for research and care. Biol Blood Marrow Transplant. 2017;23(3S):S1–9. This review summarizes recommendations by the NIH-LE-initiative (June 2016) about potentially lethal LEs, patient-centered outcome evaluation, research methodology, and healthcare delivery. As the article clearly addresses priorities for future studies and collaborative initiatives, it is recommended to clinical researchers interested in LE

    Article  PubMed  Google Scholar 

  9. Bhatia S, Davies SM, Scott Baker K, Pulsipher MA, Hansen JANCI. NHLBI first international consensus conference on late effects after pediatric hematopoietic cell transplantation: etiology and pathogenesis of late effects after HCT performed in childhood—methodologic challenges. Biol Blood Marrow Transplant. 2011;17(10):1428–35.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bresters D, van Gils IC, Kollen WJ, Ball LM, Oostdijk W, van der Bom JG, et al. High burden of late effects after hematopoietic stem cell transplantation in childhood: a single-centre study. Bone Marrow Transplant. 2010;45(1):79–85.

    Article  PubMed  CAS  Google Scholar 

  11. Dvorak CC, Gracia CR, Sanders JE, Cheng EY, Baker KS, Pulsipher MA, et al. NCI, NHLBI/PBMTC first international conference on late effects after pediatric hematopoietic cell transplantation: endocrine challenges-thyroid dysfunction, growth impairment, bone health, & reproductive risks. Biol Blood Marrow Transplant. 2011;17(12):1725–38.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dietz AC, Duncan CN, Alter BP, Bresters D, Cowan MJ, Notarangelo L, et al. The Second Pediatric Blood and Marrow Transplant Consortium International Consensus Conference on Late Effects after Pediatric Hematopoietic Cell Transplantation: defining the unique late effects of children undergoing hematopoietic cell transplantation for immune deficiencies, inherited marrow failure disorders, and hemoglobinopathies. Biol Blood Marrow Transplant. 2017;23(1):24–9.

    Article  PubMed  Google Scholar 

  13. Pulsipher MA, Skinner R, McDonald GB, Hingorani S, Armenian SH, Cooke KR, et al. National Cancer Institute, National Heart, Lung and Blood Institute/Pediatric Blood and Marrow Transplantation Consortium First International Consensus Conference on Late Effects After Pediatric Hematopoietic Cell Transplantation: the need for pediatric-specific long-term follow-up guidelines. Biol Blood Marrow Transplant. 2012;18(3):334–47.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hilgendorf I, Greinix H, Halter JP, Lawitschka A, Bertz H, Wolff D. Long-term follow-up after allogeneic stem cell transplantation. Dtsch Arztebl Int. 2015;112(4):51–8.

    PubMed  PubMed Central  Google Scholar 

  15. Gassas A, Ashraf K, Zaidman I, Ali M, Krueger J, Doyle J, et al. Hematopoietic stem cell transplantation in infants. Pediatr Blood Cancer. 2015;62(3):517–21.

    Article  PubMed  Google Scholar 

  16. Mulcahy Levy JM, Tello T, Giller R, Wilkening G, Quinones R, Keating AK, et al. Late effects of total body irradiation and hematopoietic stem cell transplant in children under 3 years of age. Pediatr Blood Cancer. 2013;60(4):700–4.

    Article  PubMed  Google Scholar 

  17. • Bresters D, Lawitschka A, Cugno C, Potschger U, Dalissier A, Michel G, et al. Incidence and severity of crucial late effects after allogeneic HSCT for malignancy under the age of 3 years: TBI is what really matters. Bone Marrow Transplant. 2016;51(11):1482–9. Five late effects (LEs) were studied within the EBMT database; the important message is that nearly all patients who were transplantated at young age develop LE: the CI of any LE at 20 years was 0.72 and in 25%, LEs were severe at a median follow-up of 10.4 years. In multivariate analysis, only TBI was a risk factor for having any LE, thyroid dysfunction, and growth disturbance. The additive risk factor of GVHD could not be proven but a possible association with the burden of LE was reported

    Article  PubMed  CAS  Google Scholar 

  18. • Vrooman LM, Millard HR, Brazauskas R, Majhail NS, Battiwalla M, Flowers ME, et al. Survival and late effects after allogeneic hematopoietic cell transplantation for hematologic malignancy at less than three years of age. Biol Blood Marrow Transplant. 2017;23(8):1327–34. This is the largest multicenter study to date (717 patients, median FU 8.3 years) in this very vulnerable patient cohort. Those who survived relapse-free ≥ 1 year had favorable OS, but more than 1 year after HSCT, 30% of patients experienced ≥ 1 LE. TBI and cGVHD were associated with adverse outcomes

    Article  PubMed  PubMed Central  Google Scholar 

  19. Peters C, Schrappe M, von Stackelberg A, Schrauder A, Bader P, Ebell W, et al. Stem-cell transplantation in children with acute lymphoblastic leukemia: a prospective international multicenter trial comparing sibling donors with matched unrelated donors—the ALL-SCT-BFM-2003 trial. J Clin Oncol. 2015;33(11):1265–74.

    Article  PubMed  CAS  Google Scholar 

  20. Bailey HK, Kappy MS, Giller RH, Gralla J. Time-course and risk factors of hypothyroidism following allogeneic hematopoietic stem cell transplantation (HSCT) in children conditioned with fractionated total body irradiation. Pediatr Blood Cancer. 2008;51(3):405–9.

    Article  PubMed  Google Scholar 

  21. Bakker B, Massa GG, Oostdijk W, Van Weel-Sipman MH, Vossen JM, Wit JM. Pubertal development and growth after total-body irradiation and bone marrow transplantation for haematological malignancies. European journal of pediatrics. 2000;159(1–2):31–7.

    Article  PubMed  CAS  Google Scholar 

  22. Felicetti F, Manicone R, Corrias A, Manieri C, Biasin E, Bini I, et al. Endocrine late effects after total body irradiation in patients who received hematopoietic cell transplantation during childhood: a retrospective study from a single institution. J Cancer Res Clin Oncol. 2011;137(9):1343–8.

    Article  PubMed  Google Scholar 

  23. Rizzari C, Conter V, Stary J, Colombini A, Moericke A, Schrappe M. Optimizing asparaginase therapy for acute lymphoblastic leukemia. Curr Opin Oncol. 2013;25(Suppl 1):S1–9.

    Article  PubMed  CAS  Google Scholar 

  24. Ricardi U, Filippi AR, Biasin E, Ciammella P, Botticella A, Franco P, et al. Late toxicity in children undergoing hematopoietic stem cell transplantation with TBI-containing conditioning regimens for hematological malignancies. Strahlenther Onkol. 2009;185(Suppl 2):17–20.

    Article  PubMed  Google Scholar 

  25. Socie G, Clift RA, Blaise D, Devergie A, Ringden O, Martin PJ, et al. Busulfan plus cyclophosphamide compared with total-body irradiation plus cyclophosphamide before marrow transplantation for myeloid leukemia: long-term follow-up of 4 randomized studies. Blood. 2001;98(13):3569–74.

    Article  PubMed  CAS  Google Scholar 

  26. Ortega JJ, Olive T, de Heredia CD, Llort A. Secondary malignancies and quality of life after stem cell transplantation. Bone Marrow Transplant. 2005;35(Suppl 1):S83–7.

    Article  PubMed  Google Scholar 

  27. • Bernard F, Auquier P, Herrmann I, Contet A, Poiree M, Demeocq F, et al. Health status of childhood leukemia survivors who received hematopoietic cell transplantation after BU or TBI: an LEA study. Bone Marrow Transplant. 2014;49(5):709–16. This is the largest pediatric multicenter study comparing late complications after TBI versus BU in acute leukemias. Although LEs were less frequent and severe after BU with a different clinical pattern, the risk to develop at least one late complication was similar including the impact on QoL

    Article  PubMed  CAS  Google Scholar 

  28. Dvorak CC, Gilman AL, Horn B, Oon CY, Dunn EA, Baxter-Lowe LA, et al. Haploidentical related-donor hematopoietic cell transplantation in children using megadoses of CliniMACs-selected CD34(+) cells and a fixed CD3(+) dose. Bone Marrow Transplant. 2013;48(4):508–13.

    Article  PubMed  CAS  Google Scholar 

  29. Chow EJ, Cushing-Haugen KL, Cheng GS, Boeckh M, Khera N, Lee SJ, et al. Morbidity and mortality differences between hematopoietic cell transplantation survivors and other cancer survivors. J Clin Oncol. 2017;35(3):306–13.

    Article  PubMed  Google Scholar 

  30. Kunkele A, Engelhard M, Hauffa BP, Mellies U, Muntjes C, Huer C, et al. Long-term follow-up of pediatric patients receiving total body irradiation before hematopoietic stem cell transplantation and post-transplant survival of > 2 years. Pediatr Blood Cancer. 2013;60(11):1792–7.

    Article  PubMed  Google Scholar 

  31. Bhatti P, Veiga LH, Ronckers CM, Sigurdson AJ, Stovall M, Smith SA, et al. Risk of second primary thyroid cancer after radiotherapy for a childhood cancer in a large cohort study: an update from the Childhood Cancer Survivor Study. Radiat Res. 2010;174(6):741–52.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Frey Tirri B, Hausermann P, Bertz H, Greinix H, Lawitschka A, Schwarze CP, et al. Clinical guidelines for gynecologic care after hematopoietic SCT. Report from the international consensus project on clinical practice in chronic GVHD. Bone Marrow Transplant. 2015;50(1):3–9.

    Article  PubMed  CAS  Google Scholar 

  33. DeFilipp Z, Duarte RF, Snowden JA, Majhail NS, Greenfield DM, Miranda JL, et al. Metabolic syndrome and cardiovascular disease following hematopoietic cell transplantation: screening and preventive practice recommendations from CIBMTR and EBMT. Bone Marrow Transplant. 2017;52(2):173–82.

    Article  PubMed  CAS  Google Scholar 

  34. Petryk A, Bergemann TL, Polga KM, Ulrich KJ, Raatz SK, Brown DM, et al. Prospective study of changes in bone mineral density and turnover in children after hematopoietic cell transplantation. J Clin Endocrinol Metab. 2006;91(3):899–905.

    Article  PubMed  CAS  Google Scholar 

  35. Ruble K, Hayat MJ, Stewart KJ, Chen AR. Bone mineral density after bone marrow transplantation in childhood: measurement and associations. Biol Blood Marrow Transplant. 2010;16(10):1451–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Le Meignen M, Auquier P, Barlogis V, Sirvent N, Contet A, Simeoni MC, et al. Bone mineral density in adult survivors of childhood acute leukemia: impact of hematopoietic stem cell transplantation and other treatment modalities. Blood. 2011;118(6):1481–9.

    Article  PubMed  CAS  Google Scholar 

  37. Kaste SC, Shidler TJ, Tong X, Srivastava DK, Rochester R, Hudson MM, et al. Bone mineral density and osteonecrosis in survivors of childhood allogeneic bone marrow transplantation. Bone Marrow Transplant. 2004;33(4):435–41.

    Article  PubMed  CAS  Google Scholar 

  38. Li X, Brazauskas R, Wang Z, Al-Seraihy A, Baker KS, Cahn JY, et al. Avascular necrosis of bone after allogeneic hematopoietic cell transplantation in children and adolescents. Biol Blood Marrow Transplant. 2014;20(4):587–92.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Gower WA, Collaco JM, Mogayzel PJ Jr. Pulmonary dysfunction in pediatric hematopoietic stem cell transplant patients: non-infectious and long-term complications. Pediatr Blood Cancer. 2007;49(3):225–33.

    Article  PubMed  Google Scholar 

  40. Liles A, Blatt J, Morris D, Wardrop R 3rd, Sharma A, Sznewajs A, et al. Monitoring pulmonary complications in long-term childhood cancer survivors: guidelines for the primary care physician. Cleve Clin J Med. 2008;75(7):531–9.

    Article  PubMed  Google Scholar 

  41. Fazekas T, Attarbaschi A, Lawitschka A, Seidel M, Potschger U, Peters C, et al. Lethal pulmonary complications after pediatric allogeneic hematopoietic stem cell transplantation. Pediatr Infect Dis J. 2012;31(2):115–9.

    Article  PubMed  Google Scholar 

  42. • Chow EJ, Anderson L, Baker KS, Bhatia S, Guilcher GM, Huang JT, et al. Late effects surveillance recommendations among survivors of childhood hematopoietic cell transplantation: a Children’s Oncology Group Report. Biol Blood Marrow Transplant. 2016;22(5):782–95. These recommendations are especially focusing on HSCT and provide a comprehensive organ-based overview, supplemented by very useful tables of exposure-based LEs, second malignancies, and guidelines for follow-up

    Article  PubMed  PubMed Central  Google Scholar 

  43. Uderzo C, Pillon M, Corti P, Tridello G, Tana F, Zintl F, et al. Impact of cumulative anthracycline dose, preparative regimen and chronic graft-versus-host disease on pulmonary and cardiac function in children 5 years after allogeneic hematopoietic stem cell transplantation: a prospective evaluation on behalf of the EBMT Pediatric Diseases and Late Effects Working Parties. Bone Marrow Transplant. 2007;39(11):667–75.

    Article  PubMed  CAS  Google Scholar 

  44. Nieder ML, McDonald GB, Kida A, Hingorani S, Armenian SH, Cooke KR, et al. National Cancer Institute-National Heart, Lung and Blood Institute/Pediatric Blood and Marrow Transplant Consortium First International Consensus Conference on Late Effects After Pediatric Hematopoietic Cell Transplantation: long-term organ damage and dysfunction. Biol Blood Marrow Transplant. 2011;17(11):1573–84.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Cubukcu CE, Sevinir B, Ercan I. Disturbed dental development of permanent teeth in children with solid tumors and lymphomas. Pediatr Blood Cancer. 2012;58(1):80–4.

    Article  PubMed  Google Scholar 

  46. Martires KJ, Baird K, Steinberg SM, Grkovic L, Joe GO, Williams KM, et al. Sclerotic-type chronic GVHD of the skin: clinical risk factors, laboratory markers, and burden of disease. Blood. 2011;118(15):4250–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  47. Bunin N, Small T, Szabolcs P, Baker KS, Pulsipher MA, Torgerson TNCI. NHLBI/PBMTC first international conference on late effects after pediatric hematopoietic cell transplantation: persistent immune deficiency in pediatric transplant survivors. Biol Blood Marrow Transplant. 2012;18(1):6–15.

    Article  PubMed  Google Scholar 

  48. Fuji S, Kapp M, Einsele H. Challenges to preventing infectious complications, decreasing re-hospitalizations, and reducing cost burden in long-term survivors after allogeneic hematopoietic stem cell transplantation. Semin Hematol. 2012;49(1):10–4.

    Article  PubMed  Google Scholar 

  49. Perkins JL, Chen Y, Harris A, Diller L, Stovall M, Armstrong GT, et al. Infections among long-term survivors of childhood and adolescent cancer: a report from the Childhood Cancer Survivor Study. Cancer. 2014;120(16):2514–21.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hilgendorf I, Freund M, Jilg W, Einsele H, Gea-Banacloche J, Greinix H, et al. Vaccination of allogeneic haematopoietic stem cell transplant recipients: report from the international consensus conference on clinical practice in chronic GVHD. Vaccine. 2011;29(16):2825–33.

    Article  PubMed  Google Scholar 

  51. Hilgendorf I, Greinix H, Halter J, Lawitschka A, Wolff D. Vaccination of allogeneic hematopoietic stem cell transplant recipients-what should be considered? Ann Hematol. 2017;96(4):701–2.

    Article  PubMed  Google Scholar 

  52. Barrera M, Atenafu E, Hancock K. Longitudinal health-related quality of life outcomes and related factors after pediatric SCT. Bone Marrow Transplant. 2009;44(4):249–56.

    Article  PubMed  CAS  Google Scholar 

  53. Sanders JE, Hoffmeister PA, Storer BE, Appelbaum FR, Storb RF, Syrjala KL. The quality of life of adult survivors of childhood hematopoietic cell transplant. Bone Marrow Transplant. 2010;45(4):746–54.

    Article  PubMed  CAS  Google Scholar 

  54. Winterling J, Johansson E, Wettergren L, Ljungman P, Alexanderson K. Occupational status among adult survivors following allogeneic stem cell transplantation in childhood. Eur J Cancer Care (Engl). 2018;27(2):e12808.

    Article  Google Scholar 

  55. Socie G, Baker KS, Bhatia S. Subsequent malignant neoplasms after hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2012;18(1 Suppl):S139–50.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Cohen A, Rovelli A, Merlo DF, van Lint MT, Lanino E, Bresters D, et al. Risk for secondary thyroid carcinoma after hematopoietic stem-cell transplantation: an EBMT Late Effects Working Party Study. J Clin Oncol. 2007;25(17):2449–54.

    Article  PubMed  Google Scholar 

  57. Parsons SK, Phipps S, Sung L, Baker KS, Pulsipher MA, Ness KKNCI. NHLBI/PBMTC First International Conference on Late Effects after Pediatric Hematopoietic Cell Transplantation: health-related quality of life, functional, and neurocognitive outcomes. Biol Blood Marrow Transplant. 2012;18(2):162–71.

    Article  PubMed  Google Scholar 

  58. • Eissa HM, Lu L, Baassiri M, Bhakta N, Ehrhardt MJ, Triplett BM, et al. Chronic disease burden and frailty in survivors of childhood HSCT: a report from the St. Jude Lifetime Cohort Study. Blood Adv. 2017;1(24):2243–6. This is the largest study evaluating the burden of chronic medical conditions in survivors of childhood malignancies treated with HSCT ( n = 112) or with conventional therapy ( n = 1106). A higher percentage of HSCT survivors had significantly more severe, disabling, or life-threatening (CTCAE grades 3–4) chronic conditions (81.3 vs 69.2%, P = 0.007) when compared to conventionally treated patients. Significantly increased chronic health conditions by age 25 years included secondary malignancies, grade 3–4 cardiovascular and pulmonary LEs, and frail health

    Article  PubMed  PubMed Central  Google Scholar 

  59. Chow EJ, Baker KS, Lee SJ, Flowers ME, Cushing-Haugen KL, Inamoto Y, et al. Influence of conventional cardiovascular risk factors and lifestyle characteristics on cardiovascular disease after hematopoietic cell transplantation. J Clin Oncol. 2014;32(3):191–8.

    Article  PubMed  Google Scholar 

  60. Majhail NS, et al. Recommended Screening and Preventive Practices for Long-term Survivors after Hematopoietic Cell Transplantation. Bone Marrow Transplant. 2012;47(3):337–341.

  61. Bhatia S, Armenian SH, Landier W. How I monitor long-term and late effects after blood or marrow transplantation. Blood. 2017;130(11):1302–14.

    Article  PubMed  CAS  Google Scholar 

  62. Balduzzi A, Dalle JH, Jahnukainen K, von Wolff M, Lucchini G, Ifversen M, et al. Fertility preservation issues in pediatric hematopoietic stem cell transplantation: practical approaches from the consensus of the Pediatric Diseases Working Party of the EBMT and the International BFM Study Group. Bone Marrow Transplant. 2017;52(10):1406–15.

    Article  PubMed  CAS  Google Scholar 

  63. Dalle JH, Lucchini G, Balduzzi A, Ifversen M, Jahnukainen K, Macklon KT, et al. State-of-the-art fertility preservation in children and adolescents undergoing haematopoietic stem cell transplantation: a report on the expert meeting of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) in Baden, Austria, 29–30 September 2015. Bone Marrow Transplant. 2017;52(7):1029–35.

    Article  PubMed  Google Scholar 

  64. • Hashmi S, Carpenter P, Khera N, Tichelli A, Savani BN. Lost in transition: the essential need for long-term follow-up clinic for blood and marrow transplantation survivors. Biol Blood Marrow Transplant. 2015;21(2):225–32. This article is recomended to clinicians who are interested in transition and are aiming for developing a late effects clinic with long-term FU

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics University Vienna, St. Anna Children’s Hospital, Kinderspitalgasse 6, 1090, Vienna, Austria

    Anita Lawitschka & Christina Peters

Authors
  1. Anita Lawitschka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anita Lawitschka.

Ethics declarations

Conflict of Interest

Anita Lawitschka and Christina Peters declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pediatric Oncology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lawitschka, A., Peters, C. Long-term Effects of Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Patients with Acute Lymphoblastic Leukemia. Curr Oncol Rep 20, 74 (2018). https://doi.org/10.1007/s11912-018-0719-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11912-018-0719-5

Keywords

Search

Navigation