General IBMFS post-HCT screening recommendations
| Late effect/organ system . | Disease-specific abnormality/concern . | Recommendations . |
|---|---|---|
| Audiology | • Risk for hearing loss | • Audiology screening if ear anomalies identified or if high risk of impairment from treatment course |
| Ophthalmology | • Vision changes, cataracts, lacrimal duct stenosis | • History and physical for changes in vision, lacrimal duct stenosis, cataracts, etc |
| Neurocognitive | • Difficulties in school/employment/home settings | • If neurological dysfunction is identified on screening history, perform diagnostic neuropsychological testing and consider referral for school support/employment guidance |
| Endocrinology | • Thyroid impairment • Growth and puberty • Fertility | • Annual TSH, T4 screening • Close height/weight monitoring, evaluation of bone health per bone mineral density recommendations • Tanner staging, physical exam, and long-term screening for premature ovarian/testicular insufficiency: FSH, LH, AMH, inhibin B |
| Bone mineral density | • Impaired bone mineral density/osteopenia with risk for fragility fractures | • Vitamin D monitoring and repletion • DXA scan posttransplanti and close monitoring in those who develop GVHD requiring systemic treatment |
| Pulmonary | • Impairment of lung function | • Annual history and physical screening • PFT every 6-12 months with referral if decline in lung function |
| Renal | • Chronic kidney disease with and without congenital anomalies • Hypertension | • Hypertensive screening at each visit or annually • Urine protein: creatinine, cystatin C urinalysis annually |
| Iron overload | • Iron overload impacting cardiac, liver, and endocrine organs | • Serum ferritin screening until resolution of overload • Consider T2-weighted MRI if screen positive or significant transfusion history • Phlebotomize posttransplant to target normal LIC if possible |
| Psychosocial/lifestyle | • Family planning/genetic counseling • Access to support networks, mental health professionals, and overall screening | • Support for patients living with chronic conditions • Family counseling with referral to genetics for those wishing to conceive • Lifestyle counseling with avoidance of smoking, limiting sun exposure/application of SPF, healthy diet • Revaccination with a focus on HPV with high malignancy risk • Referral to mental health specialist as needed |
| Late effect/organ system . | Disease-specific abnormality/concern . | Recommendations . |
|---|---|---|
| Audiology | • Risk for hearing loss | • Audiology screening if ear anomalies identified or if high risk of impairment from treatment course |
| Ophthalmology | • Vision changes, cataracts, lacrimal duct stenosis | • History and physical for changes in vision, lacrimal duct stenosis, cataracts, etc |
| Neurocognitive | • Difficulties in school/employment/home settings | • If neurological dysfunction is identified on screening history, perform diagnostic neuropsychological testing and consider referral for school support/employment guidance |
| Endocrinology | • Thyroid impairment • Growth and puberty • Fertility | • Annual TSH, T4 screening • Close height/weight monitoring, evaluation of bone health per bone mineral density recommendations • Tanner staging, physical exam, and long-term screening for premature ovarian/testicular insufficiency: FSH, LH, AMH, inhibin B |
| Bone mineral density | • Impaired bone mineral density/osteopenia with risk for fragility fractures | • Vitamin D monitoring and repletion • DXA scan posttransplanti and close monitoring in those who develop GVHD requiring systemic treatment |
| Pulmonary | • Impairment of lung function | • Annual history and physical screening • PFT every 6-12 months with referral if decline in lung function |
| Renal | • Chronic kidney disease with and without congenital anomalies • Hypertension | • Hypertensive screening at each visit or annually • Urine protein: creatinine, cystatin C urinalysis annually |
| Iron overload | • Iron overload impacting cardiac, liver, and endocrine organs | • Serum ferritin screening until resolution of overload • Consider T2-weighted MRI if screen positive or significant transfusion history • Phlebotomize posttransplant to target normal LIC if possible |
| Psychosocial/lifestyle | • Family planning/genetic counseling • Access to support networks, mental health professionals, and overall screening | • Support for patients living with chronic conditions • Family counseling with referral to genetics for those wishing to conceive • Lifestyle counseling with avoidance of smoking, limiting sun exposure/application of SPF, healthy diet • Revaccination with a focus on HPV with high malignancy risk • Referral to mental health specialist as needed |
These recommendations have been adapted from published guidelines.1-4
AMH, anti-Mullerian hormone; DXA, dual energy X-ray absorptiometry analysis; FSH, follicle-stimulating hormone; HPV, human papillomavirus; LH, luteinizing hormone; LI, liver iron content; MRI, magnetic resonance imaging; PFT, pulmonary function testing; SPF, sun protection factor; T4, thyroxine; TSH, thyroid stimulating hormone.
Swauger S, Sabulski A, Hornung L, Wasserman H, Myers KC, Howell JC. Bone health outcomes at 1 year after hematopoietic stem cell transplantation in a heterogeneous pediatric population. Transplant Cell Ther. 2022;28(1):44.e1-44.e6. doi:10.1016/j.jtct.2021.08.019.