Blood and Marrow Transplantation Long Term Management: Prevention and Complications
The science and clinical application of stem cell transplantation began soon after the Second World War, prompted by intensive research to fi nd ways to treat radiation sickness. But substantial numbers of allogeneic stem cell transplants only began to be performed in the1970s. Decade by decade the number of transplant centers has increased, and the number of successful transplants has increased. Long-term survivors from transplant thus represent a new fi eld of medicine born out of the success of a procedure that is every year becoming both increasingly applied and more successful in its outcome.
No reliable data exist as to how many long-term survivors are now living, but we can make some estimates: The World Blood and Marrow Transplantation Organization (WBMT) has assembled data from over 1400 stem cell transplant teams from 72 countries in 5 continents. In recent years the combined reported world output for stem cell transplants is in the order of 50 000 transplants a year. As a rough estimate, this represents about half a million transplants per decade, but this fi gure is conservative given a steady increase in the number of transplants being performed in all parts of the world every year. Assuming a conservative global 30% long-term survival for the 1 million transplants performed in the last 20 years, we can expect around 300 000 long-term transplant survivors. Allowing for underreporting and adding in survivors from all transplants since 1970, it is likely that there are substantially more than half a million long-term survivors from transplant world wide.
This book is therefore timely and at the same time unique: the fi rst textbook on long-term survivorship after stem cell transplantation. It will be an invaluable source for all practitioners and caregivers responsible for the lifelong management of this burgeoning group of individuals. Bipin Savani, the editor, has assembled what must be the defi nitive text on this subject and has called upon 74 co-authors to put together this authoritative book. Section 1 sets the stage, with contributions from acknowledged experts in the fi eld from Europe and the USA, covering the organizational aspects of long-term care of transplant patients. Section 2 is devoted to management of the major issues facing our survivors: second malignancies, graft-versus-host disease, infections, organ-specifi c complications, and the long-term screening systems needed to manage transplant recipients over the years. As risks of serious complications diminish, the quality of life of the survivors becomes a paramount and not-to-be forgotten consideration. It is appropriate that Section 3 , in its entirety, deals with the supportive care and management of our survivors who have been changed in many ways by the transplant procedure. Finally, the list of appendices is a source of practical “go-to” information that caregivers of all typeswill find extremely helpful in the management of our population of valiant survivors.
In clinical medicine, which is often subject to vogues and trends with short-lived impact, the care of stem cell transplant recipients stands out as a critical area of medicine which will inevitably grow in importance and remain with us over the years ahead. Blood and Marrow Transplantation Long Term Management: Prevention and Complications , is a book well shaped to introduce the fi eld and is likely to run into multiple editions in the decades to come. My congratulations go to Dr Savani and the worldclass panel of authors for this timely and essential contribution to the practice of stem cell transplantation!
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