Busulfan is an agent known to cross the blood-brain barrier and these children may require growth hormone therapy. Gonadal dysfunction is a frequent result of high-dose chemoradiotherapy. Those women who bear children after transplant require careful attention to potential obstetric complications. Preterm delivery and low birth weight were higher than expected. However, the incidence of congenital abnormalities did not appear to differ from that reported for the general population.
Bone disease is a known complication of solid organ transplantation.
However, the development of avascular necrosis, osteoporosis and fractures after stem cell transplantation is less well characterized. Increased collagen and bone turnover, increased urinary magnesium and calcium excretion were also noted. We are completing a prospective longitudinal study to identify those patients who may most benefit from anti-osteoporosis therapy. In 1989, we reported an analysis of 2,246 patients given marrow grafts in Seattle for malignant and nonmalignant conditions between 1970 and 1987. The risk was greater among younger patients at the time of transplant, especially those given prior cranial irradiation.