Komplikasi Transplantasi Sumsum Tulang

Oleh :

dr. Virly Isella

Komplikasi transplantasi sumsum tulang atau bone marrow transplant secara garis besar dapat dibagi menjadi dua, yaitu akut dan kronis. Komplikasi akut terjadi dalam waktu 90 hari pasca transplantasi. Hal ini termasuk mielosupresi dengan neutropenia, anemia, trombositopenia; sinusoidal obstruction syndrome (SOS), mukositis, graft-versus-host disease (GvHD) akut, dan infeksi.

Komplikasi kronis terjadi setelah 90 hari. Komplikasi ini termasuk GvHD kronis dan infeksi. Beberapa infeksi yang dapat terjadi yaitu pneumonia, infeksi saluran cerna bawah, ensefalitis, hepatitis, dan sistitis hemoragik.[1,6]

Mortalitas pada kasus transplantasi sumsum tulang dapat terjadi akibat kekambuhan penyakit dasar (relapse related mortality/RRM) dan non-relapse related mortality (NRM). Relaps penyakit dasar yang menyebabkan diperlukannya transplantasi adalah penyebab kematian tersering. Sementara itu, NRM dapat terjadi akibat adanya kanker sekunder, infeksi, dan disfungsi sistem organ.[13,14]

Referensi

1. Khaddour K, Hana CK, Mewawalla P. Hematopoietic Stem Cell Transplantation. [Updated 2021 Jul 1]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK536951/
2. Simpson E, Dazzi F. Bone Marrow Transplantation 1957-2019. Front Immunol. 2019;10:1246. Published 2019 Jun 5. doi:10.3389/fimmu.2019.01246
6. Moore T. Bone Marrow Transplantation. Medscape, 2017. https://emedicine.medscape.com/article/1014514-overview
13. Lida M, Nakasone H, Yamashita T, Inoue M, Ishida Y, Uchiyama H. Late Mortality and Causes of Death among Long-Term Survivors after Autologous Hematopoietic Stem Cell Transplantation. Blood Cell Therapy. 2020;1(3):11-17
14. Holmqvist AS, Chen Y, Wu J, Battles K, Bhatia R, Francisco L, et al. Late Mortality after Autologous Blood or Marrow Transplantation in Childhood: A Blood or Marrow Transplant Survivor Study-2 report. Blood. 2018;131(24):2720-2729.
15. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Sinusoidal Obstruction Syndrome (Veno-occlusive Disease) [Updated 2019 May 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548032/
16. Ahmed, S. Hematopoietic stem cell transplantation for hodgkin lymphoma. In Hematopoietic Cell Transplantation for Malignant Conditions (pp. 231-243). Elsevier. 2019. https://doi.org/10.1016/B978-0-323-56802-9.00016-X
17. Justiz Vaillant AA, Modi P, Mohammadi O. Graft Versus Host Disease. [Updated 2020 Dec 30]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK538235/
18. Chawla R. Infections After Bone Marrow Transplantation. Medscape, 2019. https://emedicine.medscape.com/article/1013470-overview
19. Wingard JR, Kauffman CA, Bond S. Overview of infections following hematopoietic cell transplantation. Uptodate, 2021. https://www.uptodate.com/contents/overview-of-infections-following-hematopoietic-cell-transplantation
20. Wingard JR, Marr KA, Bond S. Prevention of Infections in Hematopoietic Cell Transplant Recipients. Uptodate, 2021. https://www.uptodate.com/contents/prevention-of-infections-in-hematopoietic-cell-transplant-recipients
21. El-Jawahri AR, Traeger LN, Kuzmuk K, Eusebio JR, Vandusen HB, Shin JA, Keenan T, Gallagher ER, Greer JA, Pirl WF, Jackson VA, Ballen KK, Spitzer TR, Graubert TA, McAfee SL, Dey BR, Chen YB, Temel JS. Quality of life and mood of patients and family caregivers during hospitalization for hematopoietic stem cell transplantation. Cancer. 2015 Mar;121(6):951-9. Epub 2014 Dec 2.
22. Fann JR, Hubbard RA, Alfano CM, Roth-Roemer S, Katon WJ, Syrjala KL. Pre-and post-transplantation risk factors for delirium onset and severity in patients undergoing hematopoietic stem-cell transplantation. J Clin Oncol. 2011;29(7):895. Epub 2011 Jan 24.
23. Negrin R. Early complications of hematopoietic cell transplantation. Uptodate, 2020. https://www.uptodate.com/contents/early-complications-of-hematopoietic-cell-transplantation

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