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The challenge of long-term follow-up of survivors of childhood acute leukemia after hematopoietic stem cell transplantation in resource-limited countries: A single-center report from Brazil.

Journal article
Authors Daniela Hespanha Marinho
Lisandro Lima Ribeiro
Samantha Nichele
Gisele Loth
Adriana Koliski
Rebeca Toassa Gomes Mousquer
Vaneuza Araujo Moreira Funke
Kristin Page
Anders Fasth
Ricardo Pasquini
Margaret Cristina da Silva Boguszewski
Carmem Bonfim
Published in Pediatric transplantation
Volume 24
Issue 4
ISSN 1399-3046
Publication year 2020
Published at Institute of Clinical Sciences, Department of Pediatrics
Language en
Subject categories Pediatrics, Cancer and Oncology


With the number of long-term HSCT survivors steadily increasing, attention needs to be focused on the late complications and quality of life. We therefore analyzed the outcome of 101 pediatric patients (<18 years old at the time of HSCT) transplanted for acute leukemia between 1981 and 2015 at Complexo Hospital de Clínicas, Federal University of Paraná, Brazil, and who survived at least two years after HSCT. The median follow-up was 5.9 years (2.0-29.0); median age at follow-up was 17.5 years (2.98-39.0). The 5-year cumulative incidence of relapse was 27.5% (95% CI 18.6%-36.4%). Two-year cumulative incidence of chronic GVHD was 21.8% (95% CI 13.7%-29.8%). Of the 101 patients, 72 patients (71.3%) presented with late effects. Those surviving longer after HSCT experienced more complications. Patients who received TBI-based regimen developed more late effects (P = .013) and more endocrinological complications (P = .024). Endocrinological complications were the most common late sequelae found in this study. For childhood survivors, quality of life was not influenced by age (at HSCT or at last visit), time from HSCT, gender, donor, or GVHD. For survivors that no longer were children, only age at last visit impacted financial domain measures, irrespective of gender, donor, or GVHD. The current study confirms the high burden late complications after pediatric HSCT have on the survivors and underlines the importance of extended follow-up.

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