What are the long term effects of transplant, and what type of follow up care is needed?

What are the long term effects of transplant and what type of follow up care is needed?

Long term effects are possible problems that could happen in the future because of a treatment. For any patient with AML that comes through a transplant, they've already had significant chemotherapy even before they come to the transplant. We only add to that additional risk with our transplant unfortunately, which is again part of why we only go there if we need to for a patient in order to get a cure and give them the opportunity to live a nice long life.

So there are a lot of things that I have to worry about long term for patients, not only from the chemotherapy they got before their oncologist, but also because of the risk from their transplant. And each of those patients, their risks are going to be somewhat tailored to what type of chemotherapy they've received. Did they receive radiation? What kind of complications did we have after transplant? But there are some things that are fairly universal.

We know with all chemotherapy that's given, there's an increased risk for skin cancers and head and neck cancer. So wearing long term sunscreen and sun protective clothing is important for our children that are survivors of their transplant. To avoid that risk for skin cancers later in life, and that starting even the early post-transplant period, because something as simple as a sunburn can be enough irritation to trigger that immune system to attack the skin and cause graft versus host disease.

We also worry in our children about pubertal development and those that are pre-pubertal and those that are post-pubertal and those that haven't gone yet through puberty. We worry about fertility for these patients as well. So we watch growth. We watch development but we also worry about fertility.

So for patients that have gone through puberty, we try to do either sperm banking or oocyte preservation for them before they start chemotherapy. By the time they get to the transplant, they've often had a lot of chemotherapy. And there may not be a window of opportunity where we're able to get viable tissues for the chance for reproduction later. So we still will have those assessments and have those conversations, because the risk for infertility certainly only goes higher after a transplant. The high dose therapies that we give.

So for any new diagnosis patient, they should always talk with their team about is there an opportunity for fertility preservation measures to be done before we even start therapy. And if the answer for that is no, will there be one over time later on? You know, a therapy where we can try these things. And sometimes, unfortunately, the answer is still no. The window of opportunity was missed because a child is particularly sick and things like that.

And for these patients, who knows what the future will bring as far as science and technology will go. But there's also still for children or for people for whom having children and then raising children is important. There's still things like surrogacy and adoption and things like that that can be done if that's going to be something that's a part of an important fulfilled life for them.

Why should doctors proactively discuss the possibility of infertility with parents of toddlers undergoing transplant?

Typically it's not the first thing in your forefront. If you've got a toddler that you've just heard that they have a bad cancer diagnosis, you're not worried about their fertility and what's going to happen when they're 24 or 25. These are things that we need to think about. And we, as the health care providers, need to be talking about with families about some of these risks and what they are and how we try to address them or make plans for their future because we want them to have a full, happy life.