How we would monitor patient 4
| Potential late effects . | Therapeutic exposure . | Screening recommendations . |
|---|---|---|
| Cataracts | • Prednisone (3.4 g/m2) | • History of visual acuity annually |
| • TBI (1200 cGy) | • Annual ophthalmologic examination | |
| Neurocognitive dysfunction | • TBI (1200 cGy) | • Annual screening for cognitive/ vocational difficulties |
| • Formal neuropsychological evaluation if difficulties identified | ||
| Hypothyroidism | • TBI (1200 cGy) | • Serum TSH and free T4 annually |
| Cardiomyopathy | • Doxorubicin (210 mg/m2) | • History and PE annually for signs/ symptoms of CHF |
| • Echocardiogram annually | ||
| • 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 | ||
| Diabetes | • TBI (1200 cGy) | • Fasting serum glucose or hemoglobin A1C every 2 y |
| • Prednisone (3.4 g/m2) | ||
| Dyslipidemia | • TBI (1200 cGy) | • Lipid panel every 2 y |
| Hypertension | • Prednisone (3.4 g/m2) | • Annual manual BP monitoring |
| Pulmonary toxicity | • Bleomycin (60 units/m2) | • History and PE for chronic cough, shortness of breath |
| • TBI (1200 cGy) | • Pulmonary function tests at 1 y after BMT, then as clinically indicated | |
| • 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 | • TBI (1200 cGy) | • Renal function panel (serum creatinine, electrolytes) 1 y post-BMT (or at baseline visit) and then as clinically indicated |
| • Urinalysis for proteinuria, and BP monitoring yearly | ||
| Gonadal dysfunction | • Cyclophosphamide (8.4 g/m2) | • LH, FSH, estradiol at 1 y after BMT or baseline visit, then as clinically indicated |
| • Procarbazine (4.2 g/m2) | • History of sexual dysfunction and fertility problems | |
| • Melphalan (150 mg/m2) | ||
| • TBI (1200 cGy) | ||
| Osteonecrosis | • Prednisone (3.4 g/m2) | • History and PE annually to assess for joint pain and reduced range of motion |
| • TBI (1200 cGy) | • Radiograph/MRI (in the event of symptoms) | |
| Osteoporosis | • Prednisone (3.4 g/m2) | • DXA scan 1 y after BMT, then as clinically indicated |
| Peripheral neuropathy | • Vincristine (8.4 mg/m2) | • Targeted history and PE 1 y post-BMT and then as clinically indicated |
| • Vinblastine (36 mg/m2) | ○ Looking for signs/ symptoms of abnormal sensations/sensory loss, loss of balance, foot drop, etc. | |
| t-MN | • Cyclophosphamide (8.4 g/m2) | • Annual history and physical examination (for signs and symptoms of anemia and thrombocytopenia) up to 10 y after BMT |
| • Procarbazine (4.2 g/m2) | • Laboratory evaluation (complete blood count with differential, bone marrow biopsy) only if clinically indicated | |
| • Doxorubicin (210 mg/m2) | ||
| • Melphalan (150 mg/m2) | ||
| • Etoposide (2.8 g/m2) | ||
| Subsequent solid malignancies | • TBI (1200 cGy) | • Management of radiation-related breast cancer by breast oncologist |
| • Annual history and physical examination, including oral cavity, uterine cervix, external genitalia, neck for thyroid nodules, and full skin examination | ||
| • Clinical breast examination every 6 mo, annual mammograms and MRI scans of contralateral breast | ||
| • Ultrasound and fine needle aspiration (if palpable thyroid nodule identified) |
| Potential late effects . | Therapeutic exposure . | Screening recommendations . |
|---|---|---|
| Cataracts | • Prednisone (3.4 g/m2) | • History of visual acuity annually |
| • TBI (1200 cGy) | • Annual ophthalmologic examination | |
| Neurocognitive dysfunction | • TBI (1200 cGy) | • Annual screening for cognitive/ vocational difficulties |
| • Formal neuropsychological evaluation if difficulties identified | ||
| Hypothyroidism | • TBI (1200 cGy) | • Serum TSH and free T4 annually |
| Cardiomyopathy | • Doxorubicin (210 mg/m2) | • History and PE annually for signs/ symptoms of CHF |
| • Echocardiogram annually | ||
| • 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 | ||
| Diabetes | • TBI (1200 cGy) | • Fasting serum glucose or hemoglobin A1C every 2 y |
| • Prednisone (3.4 g/m2) | ||
| Dyslipidemia | • TBI (1200 cGy) | • Lipid panel every 2 y |
| Hypertension | • Prednisone (3.4 g/m2) | • Annual manual BP monitoring |
| Pulmonary toxicity | • Bleomycin (60 units/m2) | • History and PE for chronic cough, shortness of breath |
| • TBI (1200 cGy) | • Pulmonary function tests at 1 y after BMT, then as clinically indicated | |
| • 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 | • TBI (1200 cGy) | • Renal function panel (serum creatinine, electrolytes) 1 y post-BMT (or at baseline visit) and then as clinically indicated |
| • Urinalysis for proteinuria, and BP monitoring yearly | ||
| Gonadal dysfunction | • Cyclophosphamide (8.4 g/m2) | • LH, FSH, estradiol at 1 y after BMT or baseline visit, then as clinically indicated |
| • Procarbazine (4.2 g/m2) | • History of sexual dysfunction and fertility problems | |
| • Melphalan (150 mg/m2) | ||
| • TBI (1200 cGy) | ||
| Osteonecrosis | • Prednisone (3.4 g/m2) | • History and PE annually to assess for joint pain and reduced range of motion |
| • TBI (1200 cGy) | • Radiograph/MRI (in the event of symptoms) | |
| Osteoporosis | • Prednisone (3.4 g/m2) | • DXA scan 1 y after BMT, then as clinically indicated |
| Peripheral neuropathy | • Vincristine (8.4 mg/m2) | • Targeted history and PE 1 y post-BMT and then as clinically indicated |
| • Vinblastine (36 mg/m2) | ○ Looking for signs/ symptoms of abnormal sensations/sensory loss, loss of balance, foot drop, etc. | |
| t-MN | • Cyclophosphamide (8.4 g/m2) | • Annual history and physical examination (for signs and symptoms of anemia and thrombocytopenia) up to 10 y after BMT |
| • Procarbazine (4.2 g/m2) | • Laboratory evaluation (complete blood count with differential, bone marrow biopsy) only if clinically indicated | |
| • Doxorubicin (210 mg/m2) | ||
| • Melphalan (150 mg/m2) | ||
| • Etoposide (2.8 g/m2) | ||
| Subsequent solid malignancies | • TBI (1200 cGy) | • Management of radiation-related breast cancer by breast oncologist |
| • Annual history and physical examination, including oral cavity, uterine cervix, external genitalia, neck for thyroid nodules, and full skin examination | ||
| • Clinical breast examination every 6 mo, annual mammograms and MRI scans of contralateral breast | ||
| • Ultrasound and fine needle aspiration (if palpable thyroid nodule identified) |