High-dose therapy (chemotherapy with or without radiotherapy) followed either by autologous or allogeneic hematopoietic stem cell transplantation (HSCT) has improved overall survival and disease-free survival for patients with various malignant and nonmalignant hematological disorders. However, this therapeutic benefit has come at the expense of significant morbidity and occasional mortality.
Research focused on the first 3–4 weeks after the administration of high-dose therapy and HSCT (the acute phase) shows that most patients report multiple physical, affective, and cognitive symptoms. Commonly reported physical symptoms during the acute phase include nausea, vomiting, diarrhea, decreased appetite, dry mouth, insomnia, weakness, and fatigue. Cognitive symptoms, such as delirium, decreased concentration, and memory problems, also are common during the acute phase of transplantation. Numerous studies have found that patients may continue to experience distressing symptoms, such as fatigue, pain, sleep disturbance, cognitive dysfunction, eye problems, dry mouth, taste changes, cough, shortness of breath, depression, anxiety, and sexual dysfunction, months or years after transplantation.
In this chapter we examine the spectrum of symptoms produced by high-dose therapy combined with HSCT, the mechanisms underlying symptom development, and potential intervention strategies that can be used to ameliorate this symptom burden. Although HSCT can overcome the hematopoietic toxicities of cytoreductive therapies and allow patients to receive higher doses, other toxicities of high-dose therapy and HSCT may place a significant burden on patients. HSCT presents a challenge for health care providers and patients to find a balance between potentially curative therapy and the symptom burden caused by the therapy.