A Symptom-Based Approach to Early Complications of Allogeneic Hematopoietic Stem Cell Transplantation

Allogeneic hematopoietic stem cell transplantation (HSCT) offers curative potential for various hematologic malignant and non-malignant disorders. Improvements in supportive care, conditioning regimens and graft versus host disease (GVHD) prophylaxis has resulted in a reduction in non-relapse mortality and improved overall survival (OS). Despite this the early-post transplant period is fraught with complications that can significantly impact morbidity and mortality. This review adopts a symptom-based approach using clinical vignettes to highlight five critical early complications of allogeneic HSCT: neutropenic fever, GvHD, posterior reversible encephalopathy syndrome (PRES), transplant associated thrombotic microangiopathy (TA-TMA) and sinusoidal obstructive syndrome (SOS). Each of these conditions presents with non-specific symptoms – such as fever, hypertension, mental status changes or jaundice- requiring high clinical suspicion and timely intervention. Using clinical vignettes, we explore the pathophysiology, clinical presentation, diagnostic challenges and evidence-based management strategies for these complications. The goal is to equip clinicians with a practical framework for recognizing and managing these high-risk syndromes occurring in the early post-transplantation period.