DC post-HCT screening recommendations
| Late effect/organ system . | Disease-specific abnormality . | Recommendations . |
|---|---|---|
| Cancer screening | • HNSCC • Gynecological tumors/anal cancer | • Encourage HPV vaccination • Yearly gynecological evaluation for Pap smear and HPV screening • Oral and skin exams for cancer screening every 6-12 months • Patients with total-body irradiation or chest RT require screening mammography starting at age 25 or 8 years after radiation exposure (no later than 40 years)1 |
| Liver | • Liver cirrhosis/fibrosis | • Baseline liver labs yearly • Early assessment of iron overload and aggressive phlebotomy/chelation as needed after HCT • Elastography-based ultrasound with concerns • Early referral for liver consult with concerns |
| Pulmonary | • Pulmonary fibrosis • Pulmonary AVMs | • Close monitoring with screening history and physical • PFTs yearly with early referral to pulmonology with decline in pulmonary function • Imaging studies as required with a focus on avoiding unnecessary radiation exposure • Consider xenon MRI if available at local centeri • Bubble echocardiogram for AVM surveillance |
| Esophageal/GI | • Esophageal stenosis • Risk of GI bleed due to telangiectasias/varices | • Screening for stenosis with dilatation as needed • Endoscopies with GI bleed concerns |
| Reproductive | • Urethral stenosis | • Follow-up with urology for dilations |
| Bone health | • Osteopenia • Avascular necrosis | • Screening with DXA scan prior to HCT and every 2-3 years if abnormal post-HCT |
| Late effect/organ system . | Disease-specific abnormality . | Recommendations . |
|---|---|---|
| Cancer screening | • HNSCC • Gynecological tumors/anal cancer | • Encourage HPV vaccination • Yearly gynecological evaluation for Pap smear and HPV screening • Oral and skin exams for cancer screening every 6-12 months • Patients with total-body irradiation or chest RT require screening mammography starting at age 25 or 8 years after radiation exposure (no later than 40 years)1 |
| Liver | • Liver cirrhosis/fibrosis | • Baseline liver labs yearly • Early assessment of iron overload and aggressive phlebotomy/chelation as needed after HCT • Elastography-based ultrasound with concerns • Early referral for liver consult with concerns |
| Pulmonary | • Pulmonary fibrosis • Pulmonary AVMs | • Close monitoring with screening history and physical • PFTs yearly with early referral to pulmonology with decline in pulmonary function • Imaging studies as required with a focus on avoiding unnecessary radiation exposure • Consider xenon MRI if available at local centeri • Bubble echocardiogram for AVM surveillance |
| Esophageal/GI | • Esophageal stenosis • Risk of GI bleed due to telangiectasias/varices | • Screening for stenosis with dilatation as needed • Endoscopies with GI bleed concerns |
| Reproductive | • Urethral stenosis | • Follow-up with urology for dilations |
| Bone health | • Osteopenia • Avascular necrosis | • Screening with DXA scan prior to HCT and every 2-3 years if abnormal post-HCT |
These recommendations have been adapted from published guidelines.1-3
AVM, arteriovenous malformation; DXA, dual energy X-ray absorptiometry analysis; GI, gastroenterology; HNSCC, head and neck squamous cell carcinomas; HP, human papillomavirus; MRI, magnetic resonance imaging.
Walkup LL, Myers K, El-Bietar J, et al. Xenon-129 MRI detects ventilation deficits in paediatric stem cell transplant patients unable to perform spirometry. Eur Respir J. 2019;53(5):1801779. doi:10.1183/13993003.01779-2018.