Optimal Delivery of Follow-Up Care After Allogeneic Hematopoietic Stem-Cell Transplant: Improving Patient Outcomes with a Multidisciplinary Approach

Figures & data

Figure 1 Association between patient risk factors and long-term complications after allogeneic hematopoietic stem-cell transplantation (HSCT).

Figure 2 Our proposal to monitor potential complications by organ involvement.

Abbreviation: ALP, alkaline phosphatase; ALT, alanine aminotransferase; AMH, anti-müllerian hormone; AST, aspartate aminotransferase; CV, cardiovascular; FSH, follicle-stimulatiog hormone; ft4, thyroxine; HBV, Hepatitis B virus; HCV, Hepatits C virus; HDL, high-density lipoprotein; LH, luteinizing hormone; PCR, polymerase chain reaction; PFTs, pulmonary function tests; TSH, thyroid stimulating hormone.

Table 1 Suggested Hematologic Malignancies Follow-Up After Persistent Complete Remission Achievement

Disease	Suggested Follow-Up
Aplastic anemia and other non-malignant diseases	● annual CBC
Lymphoma and chronic lymphocytic leukemia	● annual chest X-Ray (if symptoms or previous localization) and abdomen US in indolent lymphomas, up to 5 years after HSCT, then only if clinically indicated ● periodic peripheral lymph nodes palpation for all others^Citation223
Acute leukemia, myelodysplastic and myeloproliferative syndromes	● annual CBC ● bone marrow examination with search for minimal residual disease up to 5 year after HSCT (3, 6, 12, 18, 24 months after HSCT, annual after second year post-transplant)
Multiple myeloma	● serum protein electrophoresis, serum free-light chain ratio, urine and serum immunofixation every 6 months ● imaging only if symptoms

Abbreviations: CBC, complete blood count; US, ultrasound; HSCT, hematopoietic stem-cell transplant.

Table 2 Suggested Cancer Screening Program

Tumor Type	Recommended Screening^a
Non-melanoma skin cancer and melanoma	● reduce UV skin exposure ● periodic self-evaluation ● annual dermatological evaluation
Thyroid cancer	● periodic neck palpation ● if using US, 5 years after RT and then once every 3–5 years if negative
Breast cancer	● annual clinical evaluation ● annual mammography/mammary MRI starting at 25 yo or 8 years after radiation, whichever occurs later, but no later than age of 40
Pulmonary cancer	● avoid/stop smoking
Oropharynx cancer	● annual dentist evaluation
Colorectal cancer	● annual FOB testing ● colonoscopy once every 5 years, starting 10 years after abdominal RT, however not before age of 40 ● rectosigmoidoscopy once every 5 years in >50 yo patients
Prostatic cancer	● periodic serum PSA level testing as indicated in general population
Cervix cancer	● Pap-test once every 1–3 years in >21 yo women
Hematologic disorders	● annual CBC, hematologic visit if abnormal
Other sites	● as per clinical indication/monitoring

Note: ^aUse proper diagnostic tools if indicated as for good clinical practice.

Abbreviations: UV, ultraviolet; US, ultrasound; RT, radiotherapy; MRI, magnetic resonance imaging; FOB, fecal occult blood; PSA, prostatic specific antigen; CBC, complete blood count; yo, years old.

Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059–3068. doi:10.1200/JCO.2013.54.880025113753

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