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Screening and preventive recommendations
ОглавлениеRecommendations on screening and preventive practices for long‐term survivors after HSCT have been published in 2006 [7], and updated in 2012 [4]. A list of the recommended screening and preventive practices for long‐term survivors after HSCT has been adapted from these publications [6]. This list includes most of the examinations and tests to be considered during the LTFU visit, and covers most of the known complications that may occur after HSCT (Table 5.3).
Table 5.3 Summary of recommendations for screening and prevention of late complications in long‐term survivors after HSCT
(Source: Adapted from Majhail [4] and Majhail and Hashmi [6].
| Recommended screening/prevention | 6 months | 1 year | Annually |
|---|---|---|---|
| Immunity | |||
| Encapsulated organism prophylaxis | 2 | 2 | 2 |
| PCP prophylaxis | 1 | 2 | 2 |
| CMV testing | 2 | 2 | 2 |
| Immunizations | 1 | 1 | 1 |
| Ocular | |||
| Ocular clinical symptom evaluation | 1 | 1 | 1 |
| Ocular fundus examination | + | 1 | + |
| Ocular examination by an expert | + | 1 | + |
| Oral | |||
| Clinical assessment | 1 | 1 | 1 |
| Dental assessment | + | 1 | 1 |
| Oral assessment by an expert | + | + | + |
| Respiratory | |||
| Clinical pulmonary assessment | 1 | 1 | 1 |
| Smoking tabaco avoidance | 1 | 1 | 1 |
| Pulmonary function testing | + | + | + |
| Chest imaging procedures | + | + | + |
| Cardiac and vascular | |||
| Cardiovascular risk factor assessment | + | 1 | 1 |
| Extended cardiac assessment by an expert | + | + | + |
| Liver | |||
| Liver function testing | 1 | 1 | 1 |
| Serum ferritin testing | 1 | + | |
| Additional diagnostic testing if indicated (liver biopsy, MRI) | + | + | + |
| Kidney | |||
| Blood pressure screening | 1 | 1 | 1 |
| Urine protein screening | 1 | 1 | 1 |
| BUN/creatinine testing | 1 | 1 | 1 |
| Further workup if clinically indicated | + | + | + |
| Muscle and connective tissue | |||
| Evaluation of muscle weakness | 2 | 2 | 2 |
| Physical activity counseling | 1 | 1 | 1 |
| Skeletal | |||
| Bone density testing (Adult women, all allogeneic recipients, all patients at high risk for bone loss) | 1 | + | |
| Nervous system | |||
| Neurologic clinical evaluation | + | 1 | 1 |
| Evaluation for cognitive development | 1 | 1 | |
| Further workup if clinically indicated (e.g., MRI, EMG, neuropsychiatry testing) | + | + | + |
| Endocrine | |||
| Thyroid function testing | 1 | 1 | |
| Growth velocity in children | 1 | 1 | |
| Gonadal function assessment (prepubertal men and women) | 1 | 1 | 1 |
| Gonadal function assessment (postpubertal women) | 1 | + | |
| Gonadal function assessment (postpubertal men) | + | + | |
| Referral to an endocrinologist when replacement therapy needed | + | + | |
| Mucocutaneous | |||
| Skin self‐examination and sun exposure counseling | 1 | 1 | 1 |
| Gynecologic examination in women | + | 1 | 1 |
| Gonadal examination in men | + | +/2 | +/2 |
| Referral to dermatologist if indicated | + | + | + |
| Second cancers | |||
| Second cancer vigilance counseling | 1 | 1 | |
| Screening for second cancers | 1 | 1 | |
| Psychosocial | |||
| Psychosocial / QoL clinical assessment* | 1 | 1 | 1 |
| Sexual function assessment | 1 | 1 | 1 |
| Spousal/caregiver/family functioning assessment | 1 | 1 | 1 |
| Fertility | |||
| Consider referral to appropriate specialist for counseling | + | + | + |
| Counsel regarding birth control posttransplantation | + | + | + |
| General | |||
| Health lifestyle recommendations (Table 5.2) | 1 | 1 | 1 |
1, recommended for all HSCT recipients; 2, recommended for patients with ongoing GVHD or immunosuppression; +, recommended for abnormal testing in a previous time period or for new signs/symptoms.
* including inquiry about school/work attendance, need for social support/disability pension, financial toxicity.
