Challenges and Opportunities in the Care of Hematopoietic Cell Transplant Survivors in the Modern Era.

With the constantly changing field of hematopoietic cell transplant (HCT) and cellular therapy and a growing number of survivors, there is an ongoing need for work to understand the changing landscape of late effects and develop interventions to optimize the long-term outcomes of survivors. In this chapter, we summarize the studies published in last 5 years describing late effects after HCT. We specifically discuss the available literature or the lack thereof for the late effects as it relates to the changes in transplant practices such as increased use of post-transplant cyclophosphamide, newer drugs to treat chronic graft vs. host disease, and chimeric antigen receptor T-cell therapy as a bridge to HCT or for a post-HCT relapse. We also summarize the recently updated recommendations for screening and management of late effects and a monitoring plan to cater to late effects specific to patients undergoing transplants for non-malignant diseases. We discuss the specific considerations such as challenges for adolescent and young adult HCT survivors, especially as they transition from pediatric to adult care. With the information discussed here, we outline challenges and opportunities for research and clinical practice highlighting the role of health care delivery models in addressing some of these issues.