How we would monitor patient 1
| Potential late effects . | Therapeutic exposure . | Screening recommendations . |
|---|---|---|
| Cardiomyopathy | • Doxorubicin (300 mg/m2) | • Active management of CHF by cardiologist (because the patient has already developed clinically overt CHF) |
| • Chest radiation (3600 cGy) | • Aggressive management of hypertension, diabetes, and dyslipidemia (goal: maintain systolic BP <120 mm Hg, HbA1C ≤6.5%, LDL <100 mg/dL, total cholesterol <200 mg/dL) | |
| • Health promotion: smoking cessation, diet rich in fruits and vegetables, physical activity per ACS guidelines | ||
| Coronary artery disease | • Chest radiation (3600 cGy) | • Electrocardiogram at periodic intervals |
| • Screening for and aggressive management of modifiable CVRFs | ||
| Pulmonary toxicity | • Bleomycin (120 units/m2) | • History and PE for chronic cough, shortness of breath annually |
| • Carmustine (300 mg/m2) | • Pulmonary function tests at 1 y after BMT, then as clinically indicated | |
| • Chest radiation (3600 cGy) | • Ensure that patient received post-BMT immunizations, particularly pneumococcal (PCV, 3 doses; PPSV23, 1 dose) because of history of chest radiation | |
| • Ensure that patient receives yearly influenza vaccine | ||
| Renal toxicity | • Ifosfamide (18 g/m2) | • Renal function panel (serum creatinine, electrolytes) 1 y post-BMT (or at baseline visit) and then as clinically indicated |
| • Carboplatin (1.6 g/m2) | • Urinalysis for proteinuria, and BP monitoring yearly | |
| Gonadal dysfunction | • Dacarbazine (4.5 g/m2) | • LH, FSH, testosterone at 1 y after BMT (or baseline visit) and then as clinically indicated |
| • Ifosfamide (18 g/m2) | • History of sexual dysfunction and fertility problems annually | |
| • Carboplatin (1.6 g/m2) | ||
| • Carmustine (300 mg/m2) | ||
| • Melphalan (140 mg/m2) | ||
| Peripheral neuropathy | • Vinblastine (72 mg/m2) | • Targeted history and PE 1 year post-BMT and then as clinically indicated |
| • Carboplatin (1.6 g/m2) | ○ Looking for signs/ symptoms of abnormal sensations/sensory loss, loss of balance, foot drop, etc. | |
| t-MN | • Doxorubicin (300 mg/m2) | Annual history and physical examination (for signs and symptoms of anemia and thrombocytopenia) up to 10 y after BMT |
| • Dacarbazine (4.5 g/m2) | • Laboratory evaluation (complete blood count with differential, bone marrow biopsy) only if clinically indicated | |
| • Ifosfamide (18 g/m2) | ||
| • Carboplatin (1.6 g/m2) | ||
| • Etoposide (1.8 g/m2) | ||
| • Carmustine (300 mg/m2) | ||
| • Melphalan (140 mg/m2) | ||
| Subsequent solid malignancies | • Chest radiation (3600 cGy) | • Annual history and physical examination, with particular attention to skin, bone, and soft tissue in the radiation field |
| Potential late effects . | Therapeutic exposure . | Screening recommendations . |
|---|---|---|
| Cardiomyopathy | • Doxorubicin (300 mg/m2) | • Active management of CHF by cardiologist (because the patient has already developed clinically overt CHF) |
| • Chest radiation (3600 cGy) | • Aggressive management of hypertension, diabetes, and dyslipidemia (goal: maintain systolic BP <120 mm Hg, HbA1C ≤6.5%, LDL <100 mg/dL, total cholesterol <200 mg/dL) | |
| • Health promotion: smoking cessation, diet rich in fruits and vegetables, physical activity per ACS guidelines | ||
| Coronary artery disease | • Chest radiation (3600 cGy) | • Electrocardiogram at periodic intervals |
| • Screening for and aggressive management of modifiable CVRFs | ||
| Pulmonary toxicity | • Bleomycin (120 units/m2) | • History and PE for chronic cough, shortness of breath annually |
| • Carmustine (300 mg/m2) | • Pulmonary function tests at 1 y after BMT, then as clinically indicated | |
| • Chest radiation (3600 cGy) | • Ensure that patient received post-BMT immunizations, particularly pneumococcal (PCV, 3 doses; PPSV23, 1 dose) because of history of chest radiation | |
| • Ensure that patient receives yearly influenza vaccine | ||
| Renal toxicity | • Ifosfamide (18 g/m2) | • Renal function panel (serum creatinine, electrolytes) 1 y post-BMT (or at baseline visit) and then as clinically indicated |
| • Carboplatin (1.6 g/m2) | • Urinalysis for proteinuria, and BP monitoring yearly | |
| Gonadal dysfunction | • Dacarbazine (4.5 g/m2) | • LH, FSH, testosterone at 1 y after BMT (or baseline visit) and then as clinically indicated |
| • Ifosfamide (18 g/m2) | • History of sexual dysfunction and fertility problems annually | |
| • Carboplatin (1.6 g/m2) | ||
| • Carmustine (300 mg/m2) | ||
| • Melphalan (140 mg/m2) | ||
| Peripheral neuropathy | • Vinblastine (72 mg/m2) | • Targeted history and PE 1 year post-BMT and then as clinically indicated |
| • Carboplatin (1.6 g/m2) | ○ Looking for signs/ symptoms of abnormal sensations/sensory loss, loss of balance, foot drop, etc. | |
| t-MN | • Doxorubicin (300 mg/m2) | Annual history and physical examination (for signs and symptoms of anemia and thrombocytopenia) up to 10 y after BMT |
| • Dacarbazine (4.5 g/m2) | • Laboratory evaluation (complete blood count with differential, bone marrow biopsy) only if clinically indicated | |
| • Ifosfamide (18 g/m2) | ||
| • Carboplatin (1.6 g/m2) | ||
| • Etoposide (1.8 g/m2) | ||
| • Carmustine (300 mg/m2) | ||
| • Melphalan (140 mg/m2) | ||
| Subsequent solid malignancies | • Chest radiation (3600 cGy) | • Annual history and physical examination, with particular attention to skin, bone, and soft tissue in the radiation field |
ACS, American Cancer Society; HbA1C, hemoglobin A1C; PE, physical examination.