الفهرس 
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Abstract
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UMMARY
ematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various malignant and non-malignant hematological diseases. The number of survivors of malignant hematological conditions is rapidly increasing worldwide. Despite recent advances in this field, transplant-related severe medical complications, including graft-versus-host disease (GVHD) and mortality, remain a major and well-documented concern.
Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep, delirium and post-traumatic stress disorder (PTSD) are the most studied conditions. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is also a major concern to consultation–liaison psychiatrists and transplant teams.
This study aims to assess all survivors of HSCT in Ain Shams University Pediatric Transplant Unit, to search for any cognitive or behavioral problems they may have and explore the impact of HSCT on their quality of life and also identify specific risk factors that may lead to adverse outcomes.
This cross-sectional study included 25 long-term survivors of HSCT with a post-transplant survival period of 3 to 10 years.
H
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The results of our present study can be summarized as follows: The median age of the included subjects was 12 (range: 5 to 23) years. In this study we found that 56% of the studied long-term survivors were males while 44% were females. The underlying diseases in the studied long term survivors included: aplastic anemia in 40% of patients, B-thalassemia major in 28%, Fanconi anemia in 4%, Acute Myeloid Leukemia in 4%, Hodgkin lymphoma in 8%, SCID in 8%, osteopetrosis in 4% of patients and HLH in 4%. In this study we illustrated that the median age at diagnosis was 3 (months to 15 years) years and the median age at transplantation was 5.8 (0.75 to 16) years. Meanwhile, the median age at the time of the study was 12 (5 to 23) years. while the median post-transplant survival period was 6 (3 - 10) years. In this study we demonstrated that 23 patients (92%) of the enrolled subjects received Allogenicperipheral blood stem cell transplant (Allo-PBSCT) while only 2 patients (8%) recieved Autologous PBSCT. 48% of the enrolled subjects received Bu/CY(busulfan and cyclophosphamide) as a conditioning regimen, while,44% received cyclophosphamide and ATG and 8% received BEAM conditioning protocol.
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In this study we illustrated that there was significant difference between weight and height of participants at time of transplant (under effect of primary disease) and time of study (under effect of transplantation) with p value(<0.001). In this study we found that 3 patients (12%) of our participants had residual of motor or mental neurological manifestation, one for lower limb mild spasticity due to viral encephalitis before transplant improving with physiotherapy and two for mental developmental delay due to primary disease) In this study we illustrated that 7 (28%) of the participants had mild anxiety, 10 patients (40%) had a moderate anxiety and 8 patients (32%) had sever anxiety, while 9 patients (36%) only reported symptoms in the pediatric symptom checklist (emotional and behavioral problems) especially if their child still very young, 11 (44%) of survivors hadn‘tsymptoms of depression while 9 patients (36%) had mild depression and 3 patients (12%) had moderate depression and only2 patients( 8%) has symptoms of severe depression within the last 2 weeks from evaluation and for management and follow up. In this study we found that Most of our participants within normal range of IQ assessment (69 to 110) except for intellectual disability (less than 69). Regarding aggregate
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(total) scale was most of participants (48%) average scale (90 to 110), 40% low average (80 to 89), and low percentage (8%) had Intellectual disability (less than 69). In this study we demonstrated that there was a statistically significant difference between the 2 genders regarding IQ aggregate scale with p value (=0.028) in which there is intellectual disability more in males (14%) than females (0%) and so on females were higher than males by 72.7% within normal average scale and 63.6% average for practical scale In this study we illustrated that there was no statistically significant difference between type of underling disease (primary diagnosis) as Aplastic anemia, Beta thalathemia and other conditions (SCID, osteopetrosis, AML and HLH) regarding any of the measured variables categories with p value (>0.05). In this study we found that there was statistical significant correlation between age of diagnosis and Rosenberg scale (self esteem score) with p value (0.026) showing that older participants at time of diagnosis had high self esteem than younger participants In this study we cleared that there was no statistical significant correlation between survival period after transplantation which represent 11 participants in between 1 to 5 survival years and 14 participants in between 6 to 10
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survival years and any of the measured variables with p value (>0.05) except for IQ aggregate scale which showed a positive significant correlation with p value (<0.008) (longer survival duration give better IQ assessment). In this study we found that there was no statistically significant difference between 3 different Conditioning protocols (busilfan and cyclophosphamide, ATG and cyclophosphamide and BEAM) regarding any of the measured variables categories with p value (>0.05) which mean they are safe for each participant according to our study scale. In this study we demonstrated that there was no statistically significant association between GVHD acute and any of the measured variables categories with p value (>0.05) as it is in very mild form (skin rash) and managed once discovered. In this study we illustrated that there was statistically significant association between GVHD chronic (popularurtecaria and skin rash) and Rosenberg scale (p <0.05). In this study we found that there was statistically significant association between post-transplant acquired acute infections (viral, fungal and bacterial) and pediatric quality of life with p value (0.047).