Common late effects after BMT
| Morbidity . | Risk factors (therapeutic exposures, comorbid conditions) . | Screening guidelines . |
|---|---|---|
| Diabetes | TBI, cranial radiation, abdominal radiation, corticosteroids, obesity | Fasting serum glucose or hemoglobin A1C every 2 y |
| Dyslipidemia | TBI, calcineurin inhibitors | Lipid panel every 2 y |
| Hypertension | Corticosteroids | Annual manual BP monitoring |
| Cardiomyopathy | Anthracyclines, pre-BMT chest radiation, CVRFs | History of cardiac compromise |
| Echocardiograms (every 1 to 5 y depending on the risk factors) | ||
| Screening for modifiable CVRFs (diabetes, dyslipidemia, hypertension) | ||
| Coronary artery disease | Pre-BMT chest radiation, CVRFs | Electrocardiogram at periodic intervals |
| Screening for modifiable CVRFs (diabetes, dyslipidemia, hypertension) | ||
| Iron overload | Multiple transfusions | Serum ferritin 1 y post-BMT, then as clinically indicated |
| Renal dysfunction | Ifosfamide, platinum-based chemotherapy, methotrexate, TBI, calcineurin inhibitors | Renal function panel (serum creatinine, electrolytes) 1y post-BMT and as clinically indicated; yearly urinalysis for proteinuria, and BP monitoring |
| Hypogonadism | Alkylating agents, TBI, cranial radiation, pelvic radiation, testicular radiation | LH, FSH, testosterone (males) |
| LH, FSH, estradiol (females) | ||
| History of sexual dysfunction and infertility | ||
| Osteoporosis | Corticosteroids, growth hormone deficiency, hypogonadism, lack of physical activity, Vitamin D deficiency | DXA scan 1 y after BMT, then as clinically indicated |
| Osteonecrosis | Corticosteroids, calcineurin inhibitors, radiation | X-ray/MRI (in the event of symptoms) |
| Thyroid disease | Radiation to the neck, TBI | Annual history to elicit symptoms of thyroid dysfunction |
| Annual TSH, FT4 | ||
| Annual palpation of thyroid gland for nodules | ||
| Cataracts, xerophthalmia | TBI, cranial radiation, corticosteroids, cGVHD | History of visual acuity |
| Annual ophthalmologic examination | ||
| Peripheral neuropathy | Plant alkaloids, heavy metals | Targeted history and physical examination 1 y post-BMT and as clinically indicated |
| Neurocognitive impairment | Cranial radiation, TBI, high-dose methotrexate and cytarabine | Annual screening for educational/ vocational difficulties |
| Formal neuropsychological evaluation if difficulties identified | ||
| Pulmonary dysfunction | Bleomycin, busulfan, nitrosoureas, chest radiation, TBI, cGVHD | Pulmonary function tests at 1 y after BMT, then as clinically indicated |
| Solid SNs | TBI, prior radiation (any site), cGVHD, cancer predisposition syndrome (Li Fraumeni, neurofibromatosis, Fanconi anemia, germline RB); hepatitis C infection, human papillomavirus infection | Annual history and physical examination, including oral cavity, uterine cervix, external genitalia, and full skin examination |
| Females: Annual breast exam, annual mammograms, and MRI scans beginning 8 y after radiation or age 25 y (whichever occurs last) | ||
| Colonoscopy every 5 y (minimum) beginning 10 y after radiation or age 35 y | ||
| Ultrasound and fine needle aspiration (for those with palpable thyroid nodules) | ||
| t-MN | Autologous BMT, TBI, alkylating agents, topoisomerase II inhibitors, peripheral blood stem cell source, lower dose of CD34 cells infused | Annual history and physical examination up to 10 y after BMT; laboratory evaluation only if clinically indicated |
| Morbidity . | Risk factors (therapeutic exposures, comorbid conditions) . | Screening guidelines . |
|---|---|---|
| Diabetes | TBI, cranial radiation, abdominal radiation, corticosteroids, obesity | Fasting serum glucose or hemoglobin A1C every 2 y |
| Dyslipidemia | TBI, calcineurin inhibitors | Lipid panel every 2 y |
| Hypertension | Corticosteroids | Annual manual BP monitoring |
| Cardiomyopathy | Anthracyclines, pre-BMT chest radiation, CVRFs | History of cardiac compromise |
| Echocardiograms (every 1 to 5 y depending on the risk factors) | ||
| Screening for modifiable CVRFs (diabetes, dyslipidemia, hypertension) | ||
| Coronary artery disease | Pre-BMT chest radiation, CVRFs | Electrocardiogram at periodic intervals |
| Screening for modifiable CVRFs (diabetes, dyslipidemia, hypertension) | ||
| Iron overload | Multiple transfusions | Serum ferritin 1 y post-BMT, then as clinically indicated |
| Renal dysfunction | Ifosfamide, platinum-based chemotherapy, methotrexate, TBI, calcineurin inhibitors | Renal function panel (serum creatinine, electrolytes) 1y post-BMT and as clinically indicated; yearly urinalysis for proteinuria, and BP monitoring |
| Hypogonadism | Alkylating agents, TBI, cranial radiation, pelvic radiation, testicular radiation | LH, FSH, testosterone (males) |
| LH, FSH, estradiol (females) | ||
| History of sexual dysfunction and infertility | ||
| Osteoporosis | Corticosteroids, growth hormone deficiency, hypogonadism, lack of physical activity, Vitamin D deficiency | DXA scan 1 y after BMT, then as clinically indicated |
| Osteonecrosis | Corticosteroids, calcineurin inhibitors, radiation | X-ray/MRI (in the event of symptoms) |
| Thyroid disease | Radiation to the neck, TBI | Annual history to elicit symptoms of thyroid dysfunction |
| Annual TSH, FT4 | ||
| Annual palpation of thyroid gland for nodules | ||
| Cataracts, xerophthalmia | TBI, cranial radiation, corticosteroids, cGVHD | History of visual acuity |
| Annual ophthalmologic examination | ||
| Peripheral neuropathy | Plant alkaloids, heavy metals | Targeted history and physical examination 1 y post-BMT and as clinically indicated |
| Neurocognitive impairment | Cranial radiation, TBI, high-dose methotrexate and cytarabine | Annual screening for educational/ vocational difficulties |
| Formal neuropsychological evaluation if difficulties identified | ||
| Pulmonary dysfunction | Bleomycin, busulfan, nitrosoureas, chest radiation, TBI, cGVHD | Pulmonary function tests at 1 y after BMT, then as clinically indicated |
| Solid SNs | TBI, prior radiation (any site), cGVHD, cancer predisposition syndrome (Li Fraumeni, neurofibromatosis, Fanconi anemia, germline RB); hepatitis C infection, human papillomavirus infection | Annual history and physical examination, including oral cavity, uterine cervix, external genitalia, and full skin examination |
| Females: Annual breast exam, annual mammograms, and MRI scans beginning 8 y after radiation or age 25 y (whichever occurs last) | ||
| Colonoscopy every 5 y (minimum) beginning 10 y after radiation or age 35 y | ||
| Ultrasound and fine needle aspiration (for those with palpable thyroid nodules) | ||
| t-MN | Autologous BMT, TBI, alkylating agents, topoisomerase II inhibitors, peripheral blood stem cell source, lower dose of CD34 cells infused | Annual history and physical examination up to 10 y after BMT; laboratory evaluation only if clinically indicated |
CVRF, cardiovascular risk factors; MRI, magnetic resonance imaging; RB, retinoblastoma.