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Late effects after hematopoietic stem cell transplantation--critical issues.

Today, long-term prognosis after hematopoietic stem cell transplantation (HSCT) has greatly improved. Nevertheless, there are still a number of malignant and nonmalignant late effects that can cause substantial morbidity, with considerable impact on the health status and quality of life in the long-term survivors. Transplant-preparative regimen and graft-versus-host disease are considered the main risk factors after allogeneic HSCT. The continuous changes in the transplantation practice and in the type of patients selected are responsible that the pattern of the late effects after HSCT is changing over time. Relevant recent changes concern the avoidance of total body irradiation conditioning whenever possible, the higher age of the patients transplanted, the increasing use of unrelated donors as well as the introduction of reduced intensity conditioning. The detection of an increasing number of late effects should not be considered as a drawback of HSCT. The experience gathered during the past decades has become the main source of information on which the current management of the long-term survivors is based. A broad expertise is mandatory to manage long-term survivors. Aftercare of long-term survivors includes a standardized screening, counseling of the patients as well as prevention and treatment of late effects. Counseling should include self-examination for early cancer detection, and advice for healthy lifestyle behavior. Beyond immediate survival, allogeneic HSCT is a lifelong commitment between long-term survivors and the transplant team, involving the recipient's family and the general health care providers. Proper information on 'life after HSCT' should also be provided to the whole community, which plays a key role in the social reinsertion of the long-term survivors.