Long-term health maintenance after BMT

You see a 30 year lady who received a matched unrelated donor allogeneic hematopoietic cell transplant for high-risk acute myeloid leukemia in CR1 5 years ago. She has recently moved to town and presents to establish care. She received high dose cyclophosphamide and total body irradiation based myeloablative conditioning regimen. Her early post-transplant course was complicated by CMV reactivation and acute graft-versus-host disease of the skin and GI tract, which responded well to prednisone. However, it did progress to chronic graft-versus-host disease of both organs which required treatment with prednisone for 9 months. She was successfully tapered off immune suppression at 1 year post-transplant. She feels well today, is working full time as a teacher, and has no specific health issues or concerns. What is her risk of relapse at this time? What about risk of late complications? What evaluations or assessments would you like to pursue to screen for and prevent late complications?

Clinical Cases and Images

Coronal contrast enhanced abdominal CT in a patient status post bone marrow transplant shows diffuse wall thickening (arrow) of ileal and colonic loops consistent with graft versus host disease. Graft versus host disease is an immune-related complication of bone marrow transplant where the transplanted immune system attacks the recipient tissues. The skin is most commonly affected. However, this is usually not visible on imaging. On imaging, the most commonly affected organ is the gastrointestinal tract where bowel wall thickening may be present.

Coronal CT of the abdomen in a patient status post bone marrow transplant shows diffuse bowel wall thickening affecting both the small bowel and colon. Graft versus host disease is the second leading cause of death after stem cell transplant. Additionally, acute graft versus host disease was defined as occurring within the first 100 days following stem cell transplant while chronic graft-versus-host disease was said to occur after 100 days. In 2014, the NIH revised the criteria for distinguishing between acute and chronic disease.

Cutaneous graft versus host disease developing 4 months after matched sibling allogeneic pbsc transplant for Ph+ acute lymphoblastic leukemia.