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Long-term Side Effects from ASCT
In my experience, long-term side effects from ASCT are more serious, more life-changing than the short-term side effects discussed in the article linked below.
Let me rephrase that. While nausea, vomiting, alopecia, mucositis, etc. are difficult side effects, they are temporary and manageable. While it was going on, my nausea affected my quality-of-live more than my chemotherapy-induced atrial fibrillation aka Afib does.
In my experience, oncology thinks short-term meaning five years or less. Long-term side effects, are, by definition, long-term. The cancer patient may not know enough to understand that his/her melaphalan, for example, caused their chemotherapy-induced cardiomyopathy because it was diagnosed years after their ASCT.
What are the long-term adverse events that can result from stem cell transplantation for multiple myeloma?
- Graft-Versus-Host Disease (GVHD): Primarily associated with allogeneic SCT, where stem cells are from a donor. GVHD occurs when the donor’s immune cells attack the recipient’s tissues, potentially affecting the skin, liver, and gastrointestinal tract. Chronic GVHD can persist for years and require ongoing treatment.
- Infections: Patients are at increased risk for infections due to prolonged immunosuppression. This risk can persist long-term, particularly in those with chronic GVHD or other immune dysfunctions.
- Treatment-related Secondary Cancer: There is an elevated risk of developing secondary malignancies, including acute myeloid leukemia (AML), myelodysplastic syndromes (MDS), and solid tumors, due to the high-dose chemotherapy and radiation used during SCT.
- Organ Damage: High-dose chemotherapy can cause long-term damage to organs such as the heart, lungs, liver, and kidneys. This can lead to conditions such as cardiomyopathy, pulmonary fibrosis, liver dysfunction, and renal impairment.
- Endocrine Disorders: SCT can lead to endocrine dysfunctions, including thyroid disorders, adrenal insufficiency, and gonadal failure, resulting in issues like infertility, sexual dysfunction, and growth problems in younger patients.
- Bone Health: Osteopenia and osteoporosis are common long-term issues, increasing the risk of fractures. This is partly due to the disease itself and the treatments, including steroids.
- Neurological Effects: Peripheral neuropathy, cognitive changes, and other neurological issues can occur due to the chemotherapy and other treatments used in SCT.
- Fatigue and Quality of Life: Chronic fatigue and reduced quality of life are common long-term effects, often due to a combination of physical, emotional, and psychological factors.
- Hormonal Imbalances: Patients may experience hormonal imbalances leading to issues like thyroid dysfunction or adrenal insufficiency.
- Treatment-induced Relapse-chemotherapy and radiation increase the patient’s relapse risk
- Chronic Non-Cancer Pain- pain resulting from high-dose chemotherapy.
- Treatment-induced Aging-chemotherapy and radiation, simply put, age patients.
- Treatment-induced Hemorrhagic Cystitis– sometimes referred to as irritable bladder. Often caused by cytoxan/cyclophosphomide.
The article below implies that hematopoietic stem cell transplantation is the only choice for newly diagnosed myeloma patients. This is simply not true. Numerous studies have documented that combinations of novel therapies result in just as long an average overall survival and fewer side effects than does hematopoietic stem cell transplantation.
Most if not all of the above long-term side effects can be minimized if not completely avoided with evidence-based non-conventional therapies. Again, the challenge is that conventional oncology knows little about managing long-term side effects.
If you are a newly diagnosed myeloma patient and are concerned about long-term side effects from ASCT email me at David.PeopleBeatingCancer@gmail.com
thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Prevention and management of acute toxicities from conditioning regimens during hematopoietic stem cell transplantation
“Hematopoietic stem cell transplantation (HSCT) remains the only curative option for several hematological malignancies. Its use has continued to grow, with an estimated 23,500 transplants performed annually in the United States alone.
The acute toxicities that occur from conditioning chemotherapy can impact the peri-transplant period and have substantial implications on patients’ tolerability and outcomes, irrespective of the treatment of their disease.
- Chemotherapy-induced nausea vomiting (CINV),
- mucositis,
- transplant-associated thrombotic microangiopathy (TA-TMA),
- and sinusoidal obstruction syndrome, also known as a veno-occlusive disease (SOS/VOD)
can all have significant implications for patients. These acute complications begin with the start of conditioning chemotherapy and add to potential toxicity for patients throughout the early post-transplant period, from Day +30 for CINV, mucositis, and SOS, and which can continue through at least Day +100 with the onset of TA-TMA.
These toxicities must be prevented and managed appropriately. This review will summarize the literature surrounding them and guide their management…
Conclusion
Acute complications associated with conditioning regimens in HSCT patients are important to identify and to promptly manage. Table 5 includes a summary of all complications discussed within this review, as well as considerations based on the type of HSCT.
With the continued growth of HSCT, recognition and care throughout the peri-transplantation period is imperative to avoid unnecessary toxicity and provide best outcomes for patients.