Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 75

The long‐term follow‐up (LTFU) program aims to provide care for childhood and adulthood survivors after hematopoietic stem cell transplant (HSCT). LTFU care of transplanted survivors includes screening and prevention of late complications of the HSCT, education about the possible late consequences of the transplantation, and monitoring of healthcare needs according to risk profile of the survivor.

For transplanted patients in remission from their primary disease and without active chronic graft‐versus‐host disease (GVHD), annual follow‐up visits are considered as a standard. More frequent controls may be required for patients with active chronic GVHD (cGVHD), recurrent infectious complications or other posttransplant complications which need close guidance from experts in posttransplant care. Because long‐term survivors may live in geographical areas far from the transplant center and have usually returned to work, the follow‐up visit should be well prepared in advance to reduce unnecessary long waiting times and avoid forgetting essential elements of LTFU services. Therefore, a well‐adapted LTFU calendar has to be established for each survivor. Health risk after HSCT is strongly associated with a number of factors, which are related to the primary disease and its previous treatment, as well as to the transplantation procedure itself. Since the magnitude of risk and the severity of late complications for an individual patient may greatly vary, the follow‐up care should be individualized on the basis of the patient’s history. For instance, cGVHD is associated with greater risk of secondary squamous cell cancer of the skin and mucosa, while total body irradiation (TBI) increases the risk of breast cancer. There are basic screening and prevention elements that apply to all survivors. Other recommendations depend on the risk of a late complication for a long‐term survivor.

In this chapter, the survivorship care plan, schedule of the LTFU visit, and recommendations for screening and preventive measurements of posttransplant survivors are discussed.