Canterbury DHB

Context

Late follow-up of transplant survivors - summary for referring physicians and GPs

 

Late complications

Action

Special groups

Infections

CMV reactivation

PCP

Encapsulated organisms

HSV/VZV reactivation

Toxoplasma

Cotrimoxazole for 1 year (PCP and Toxoplasma)

Penicillin 500 mg BD for 18 months

Valaciclovir 500 mg BD for 1 year

Revaccination at 1 year

Continue for longer while on treatment for GVHD

CMV/EBV screening to continue while active GVHD

Ocular

Cataracts

Sicca syndrome

Retinopathy

Yearly ophthalmology exam

 

Oral

Xerostomia

Caries

Education about dental health

Yearly dental examination

Yearly examination for oral complications

 

Respiratory

Bronchiolitis obliterans

Smoking cessation advice

Clinical evaluation

PFT at 1 year

 

Cardiovascular

Cardiovascular disease

Cardiomyopathy

Hypertension

Healthy heart education

Assessment and treatment of risk factors

Endocarditis prophylaxis?

 

Liver

Iron overload

Hepatitis B/C

Yearly LFT

Serum ferritin at 1 year

Venesection may be required if multiple RBC transfusions and ferritin >1000

Renal

Chronic kidney disease

Yearly creatinine and electrolytes

 

GU

Genital GVHD

Yearly assessment of genital GVHD

 

Muscle and connective tissue

Myopathy

Scleroderma

Encourage physical activity

 

Skeletal

Osteoporosis

Avascular necrosis

Encourage physical activity

Screen need for vitamin D and Ca++ replacement

DEXA scan at 1 year for all women, all allogeneic HSCT recipients and men at high risk

Consider baseline DEXA in patients with GVHD or planned prolonged steroid exposure (>20 mg prednisone for equivalent for >4 weeks), CNI, older age

Endocrine

Hypothyroidism

Hypogonadism

Yearly thyroid function tests

Clinical and endocrinology assessment for hypogonadism in post-pubertal women

Gonadal function assessment in men

Patients with prolonged steroid exposure may require synacthen test and if cortisol deficient stress doses during intercurrent illness

Mucocutaneous

Secondary skin cancers

Education on self-skin examination and sunlight exposure

Patients with cGVHD and TBI may require specialist assessment

Second cancers

Post transplant lympho-proliferative disease

AML/MDS

Solid tumours

Education about second cancers and prevention, e.g. smoking cessation

Follow general population advice for screening

For TBI recipients mammography should start earlier

Psychosocial

Mental health issues

Fatigue

Sexual dysfunction

Clinical assessment of mental health, cognitive function, fatigue and sexual dysfunction

Referral for specialist opinion if necessary

Fertility

Infertility

Referral to specialist if necessary

 

For compliance, the following ASBMT guideline is a highly recommended resource to follow:

Recommended Screening and Preventive Practices for Long-Term Survivors after Hematopoietic Cell Transplantation: Joint Recommendations of the European Group for Blood and Marrow Transplantation, the Center for International Blood and Marrow Transplant Research, and the American Society of Blood and Marrow Transplantation”.

About this Canterbury DHB document (112993):

Document Owner:

Not assigned (see Who's Who)

Issue Date:

December 2016

Next Review:

December 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 112993