Various surveillance guidelines following hematopoietic stem cell transplant
| Organ system . | Late effects . | Children's Oncology Group27 . | National Marrow Donor Program28 . | Bhatia et al29 . | SCD specific consortium30 . | Fitzhugh et al31 . |
|---|---|---|---|---|---|---|
| Cardiovascular | Elevated TRJV, pulmonary and systemic HTN, systolic/diastolic dysfunction, dyslipidemia, cardiac iron overload, myocardial strain | Yearly BP; lipids every 2 years; echo every 1-5 years | Regular monitoring of risk factors and complications but no specific time frame | Yearly BP; lipids every 2 years; echo every 1-5 years | Yearly BP and echo; lipids every 5 years | Yearly BP and echo; lipids every 1-2 years; cardiac MRI monitoring in those with cardiac iron overload before HSCT; cardiology/pulmonology consult for those with severe cardiac disease |
| Pulmonary | Decreased pulmonary function | PFTs at 1-year post-HSCT | PFTs at 6 mo, 12 mo, yearly | PFTs at 1-year post- HSCT | PFTs at 3, 6, and 12 mo and then yearly for 2 years; yearly PFTs for those with early compromise or chronic GVHD until off immunosuppressive medications; echo with evaluation of TRJV at 1 year; pulmonary arterial pressure if TRJV >3 m/s to confirm pulmonary HTN | PFTs at 3, 6, and 12 mo post-HSCT, then yearly; less frequent studies for patients who are not symptomatic, are free of GVHD, and have stable PFTs; pulmonary consultation for those with new or worsening abnormal PFTs |
| Renal | Hyperfiltration, proteinuria, acute/chronic renal disease, sickle cell nephropathy | Renal function for 1 year; yearly UA and BP | BP and renal function tests at 6 mo, 1 year, yearly | Renal function at 1 year; yearly UA and BP | Monitor until off nephrotoxic therapy and yearly for 2 years; UA for blood/protein at 1 year. Microalbuminuria testing yearly for 2 years; yearly BP | Monitor renal function until off nephrotoxic therapy and then yearly; less frequent testing for patients with stable electrolytes and renal function; yearly UA and BP; renal consultation for patients with renal dysfunction |
| Reproductive | Impaired fertility, infertility, delayed puberty, sexual dysfunction | Tanner every 6 months; testosterone by age 14; age-appropriate sperm analysis; LH, FSH, estradiol by age 13 | 1 year and yearly thereafter | Hormone levels without specified interval | Yearly physical examination and Tanner staging; testosterone, LH, and FSH in males ≥11 years, yearly for 2 years; age- appropriate sperm analysis; LH, FSH, AMH, and estradiol in female patients ≥11 years, at 1 and 2 years post-HSCT | — |
| Organ system . | Late effects . | Children's Oncology Group27 . | National Marrow Donor Program28 . | Bhatia et al29 . | SCD specific consortium30 . | Fitzhugh et al31 . |
|---|---|---|---|---|---|---|
| Cardiovascular | Elevated TRJV, pulmonary and systemic HTN, systolic/diastolic dysfunction, dyslipidemia, cardiac iron overload, myocardial strain | Yearly BP; lipids every 2 years; echo every 1-5 years | Regular monitoring of risk factors and complications but no specific time frame | Yearly BP; lipids every 2 years; echo every 1-5 years | Yearly BP and echo; lipids every 5 years | Yearly BP and echo; lipids every 1-2 years; cardiac MRI monitoring in those with cardiac iron overload before HSCT; cardiology/pulmonology consult for those with severe cardiac disease |
| Pulmonary | Decreased pulmonary function | PFTs at 1-year post-HSCT | PFTs at 6 mo, 12 mo, yearly | PFTs at 1-year post- HSCT | PFTs at 3, 6, and 12 mo and then yearly for 2 years; yearly PFTs for those with early compromise or chronic GVHD until off immunosuppressive medications; echo with evaluation of TRJV at 1 year; pulmonary arterial pressure if TRJV >3 m/s to confirm pulmonary HTN | PFTs at 3, 6, and 12 mo post-HSCT, then yearly; less frequent studies for patients who are not symptomatic, are free of GVHD, and have stable PFTs; pulmonary consultation for those with new or worsening abnormal PFTs |
| Renal | Hyperfiltration, proteinuria, acute/chronic renal disease, sickle cell nephropathy | Renal function for 1 year; yearly UA and BP | BP and renal function tests at 6 mo, 1 year, yearly | Renal function at 1 year; yearly UA and BP | Monitor until off nephrotoxic therapy and yearly for 2 years; UA for blood/protein at 1 year. Microalbuminuria testing yearly for 2 years; yearly BP | Monitor renal function until off nephrotoxic therapy and then yearly; less frequent testing for patients with stable electrolytes and renal function; yearly UA and BP; renal consultation for patients with renal dysfunction |
| Reproductive | Impaired fertility, infertility, delayed puberty, sexual dysfunction | Tanner every 6 months; testosterone by age 14; age-appropriate sperm analysis; LH, FSH, estradiol by age 13 | 1 year and yearly thereafter | Hormone levels without specified interval | Yearly physical examination and Tanner staging; testosterone, LH, and FSH in males ≥11 years, yearly for 2 years; age- appropriate sperm analysis; LH, FSH, AMH, and estradiol in female patients ≥11 years, at 1 and 2 years post-HSCT | — |
AMH, anti-Mullerian hormone; BP, blood pressure; echo, echocardiogram; FSH, follicle-stimulating hormone; HTN, hypertension; LH, luteinizing hormone; MRI, magnetic resonance imaging; UA, urinalysis.