Complications of autologous hematopoietic stem cell transplantation

Myeloablative therapy followed by autologous hematopoietic stem cell (HSC) transplantation is a therapeutic option proposed for a variety of hematolog ical and non-hematological diseases. However, although mortality due to thi s procedure is steadily decreasing, patients are still exposed to the risk of a number of complications negatively affecting their expectancy or quali ty of life. Adverse events due to HSC harvesting are rare and generally rev ersible. The early post-transplant complications include infections, mucosi tis, hepatic veno-occlusive disease and various acute organ toxicities. Imm une derangement is a leading cause of most late events, such as viral or fu ngal infections, auto-immune manifestations and secondary neoplasms, of whi ch secondary AML/MDS are the most commonly reported. In line with the favou red pathogenetic explanation, neoplastic clones previously established duri ng conventional treatment are harvested and reinfused at the time of autogr afting. Other late effects are single organ dysfunction due to the underlyi ng disease and treatment toxicities combined with infectious and post-infec tious phenomena. The lungs, heart, CNS and reproductive system are the most investigated targets, but no clinical patterns have been identified as spe cific for autografting.