What Care Do I Need After a Stem Cell Transplant?

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A stem cell transplant can be a lifesaving treatment for patients with leukemia, lymphoma, multiple myeloma, or certain blood-related disorders. In many cases, however, transplants increase patients’ risk for an array of long-term health problems, often caused by the high doses of chemotherapy and/or radiation therapy used prior to the transplant.

Dana-Farber’s Adult Stem Cell Survivorship Clinic helps transplant survivors manage the physical and psychological challenges associated with long-term recovery from transplantation. Held once a month for allogenic transplant patients who are at least a year past their transplant, the clinic provides a one-stop opportunity for survivors to meet with physicians and others who specialize in areas relating to post-transplant complications.

“Survivors meet individually with a nurse practitioner trained in Survivorship Medicine as well as specialists in dermatology, oral medicine, and opthalmology, and as a group with a nutritionist, exercise physiologist, and social worker,” says the clinic’s director, Corey Cutler, MD, MPH.

Corey Cutler, MD, MPH.

During the clinic, patents receive an individualized care plan that reviews their treatment and lays out the health issues they should watch for in the coming years. The plan is sent to their primary care physician as well.

The clinic helps survivors be attuned to a variety of common long-term risks and ways of reducing them, including:

  • A higher rate of skin cancer. Specialists educate patients on ways to limit sun exposure.
  • A higher rate of oral malignancies, tooth loss, and tooth decay, often caused by dry mouth. Patients learn about  oral care, monitoring, and treatments for dry mouth.
  • Dry eye and early development of cataracts. Clinicians review approaches to treating and preventing dry eye.

Survivors at risk for other, less common long-term complications, such as cardiovascular disease or kidney disease, are referred to the appropriate specialists at Brigham and Women’s Hospital, Dana-Farber’s partner in adult cancer care. All patients also have access to Dana-Farber’s Adult Survivorship Program.

Long-term complications are a concern regardless of what type of transplant an individual has had, Cutler says – whether the transplanted cells came from an outside donor or the patient him- or herself, or whether the transplant entailed high doses of chemotherapy or the somewhat lower doses used in a reduced-intensity (or “mini”) transplant.

“Our job is to address these potential issues early and in a preventive fashion so they don’t become problems,” he explains. Survivors’ caregivers – often, family members who help out during the transplant recovery period – are invited to attend the group sessions with nutritionists and social workers to learn strategies for providing care.

The health issues covered at the clinic are distinct from those that may arise from the transplant itself, Cutler notes. These can include graft-versus-host disease, a potentially severe condition in which transplanted immune system cells attack a patient’s healthy tissue, and infections resulting from the use of immunosuppressive drugs.  For that reason, patients make periodic visits to their transplant physician, often for many years after the transplant.

Learn more about adult survivorship care at Dana-Farber.

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