Late complications arising after allogeneic transplantation are of increasing importance to hematologists and primary care providers as an increasing number of long-term survivors now are more than 25 years after transplantation. Chronic GVHD is the major determinant of late morbidity and mortality after allogeneic stem cell transplantation. New approaches to treatment include the use of FK-506, thalidomide, mycophenolate mofetil, and rapamycin. Long-term administration of IVIg in the absence of hypogammaglobulinemia has not been beneficial. 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.