How we would monitor patient 2
| Potential late effects . | Therapeutic exposure . | Screening recommendations . |
|---|---|---|
| Cataracts | • Corticosteroids | • History of visual acuity annually |
| • TBI (1320 cGy) | • Annual ophthalmologic examination | |
| Neurocognitive dysfunction | • Cytarabine (6.7 g/m2) | • Annual screening for cognitive/vocational difficulties |
| • TBI (1320 cGy) | • Formal neuropsychological evaluation if difficulties identified | |
| Hypothyroidism | • TBI (1320 cGy) | • Active management of hypothyroidism by endocrinologist (patient presented with overt hypothyroidism) |
| Cardiomyopathy | • Daunorubicin (270 mg/m2) | • History and PE annually for signs/ symptoms of CHF |
| • Idarubicin (36 mg/m2) | • 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 (1320 cGy) | • Fasting serum glucose or HbA1C every 2 y |
| • Corticosteroids | ||
| Dyslipidemia | • TBI (1320 cGy) | • Lipid panel every 2 y |
| • Sirolimus | ||
| Hypertension | • Corticosteroids | • Annual manual BP monitoring |
| Pulmonary toxicity | • TBI (1320 cGy) | • History and PE for chronic cough, shortness of breath |
| • Pulmonary function tests at 1 y after BMT, then as clinically indicated | ||
| • Assure that patient received post-BMT immunizations, particularly pneumococcal (PCV, 3 doses; PPSV23 1 dose) because of history of chest radiation | ||
| • Assure that patient receives yearly influenza vaccine | ||
| Renal toxicity | • TBI (1320 cGy) | • Renal function panel (serum creatinine, electrolytes) 1 y post-BMT (or at baseline visit) and then as clinically indicated |
| • Sirolimus | • Urinalysis for proteinuria, and BP monitoring yearly | |
| Gonadal dysfunction | • Cyclophosphamide (3.2 g/m2) | • LH, FSH, estradiol (females) at 1 y after BMT (or baseline visit) and then as clinically indicated |
| • TBI (1320 cGy) | • History of sexual dysfunction and fertility problems | |
| Osteonecrosis | • Corticosteroids and sirolimus | • History and PE annually to assess for joint pain and reduced range of motion |
| • TBI (1320 cGy) | • Radiograph/MRI (in the event of symptoms) | |
| Osteoporosis | • Corticosteroids | • DXA scan 1 y after BMT, then as clinically indicated |
| • Sirolimus | ||
| t-MN | • Cyclophosphamide (3.2 g/m2) | • Annual history and physical examination (for signs and symptoms of anemia and thrombocytopenia) up to 10 y after BMT |
| • Daunorubicin (270 mg/m2) | • Laboratory evaluation (complete blood count with differential, bone marrow biopsy) only if clinically indicated | |
| • Idarubicin (36 mg/m2) | ||
| Subsequent solid malignancies | • TBI (1320 cGy) | • 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 beginning 8 y after radiation or age 25 y (whichever occurs last) | ||
| • Ultrasound and fine needle aspiration (for those with palpable thyroid nodules) |
| Potential late effects . | Therapeutic exposure . | Screening recommendations . |
|---|---|---|
| Cataracts | • Corticosteroids | • History of visual acuity annually |
| • TBI (1320 cGy) | • Annual ophthalmologic examination | |
| Neurocognitive dysfunction | • Cytarabine (6.7 g/m2) | • Annual screening for cognitive/vocational difficulties |
| • TBI (1320 cGy) | • Formal neuropsychological evaluation if difficulties identified | |
| Hypothyroidism | • TBI (1320 cGy) | • Active management of hypothyroidism by endocrinologist (patient presented with overt hypothyroidism) |
| Cardiomyopathy | • Daunorubicin (270 mg/m2) | • History and PE annually for signs/ symptoms of CHF |
| • Idarubicin (36 mg/m2) | • 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 (1320 cGy) | • Fasting serum glucose or HbA1C every 2 y |
| • Corticosteroids | ||
| Dyslipidemia | • TBI (1320 cGy) | • Lipid panel every 2 y |
| • Sirolimus | ||
| Hypertension | • Corticosteroids | • Annual manual BP monitoring |
| Pulmonary toxicity | • TBI (1320 cGy) | • History and PE for chronic cough, shortness of breath |
| • Pulmonary function tests at 1 y after BMT, then as clinically indicated | ||
| • Assure that patient received post-BMT immunizations, particularly pneumococcal (PCV, 3 doses; PPSV23 1 dose) because of history of chest radiation | ||
| • Assure that patient receives yearly influenza vaccine | ||
| Renal toxicity | • TBI (1320 cGy) | • Renal function panel (serum creatinine, electrolytes) 1 y post-BMT (or at baseline visit) and then as clinically indicated |
| • Sirolimus | • Urinalysis for proteinuria, and BP monitoring yearly | |
| Gonadal dysfunction | • Cyclophosphamide (3.2 g/m2) | • LH, FSH, estradiol (females) at 1 y after BMT (or baseline visit) and then as clinically indicated |
| • TBI (1320 cGy) | • History of sexual dysfunction and fertility problems | |
| Osteonecrosis | • Corticosteroids and sirolimus | • History and PE annually to assess for joint pain and reduced range of motion |
| • TBI (1320 cGy) | • Radiograph/MRI (in the event of symptoms) | |
| Osteoporosis | • Corticosteroids | • DXA scan 1 y after BMT, then as clinically indicated |
| • Sirolimus | ||
| t-MN | • Cyclophosphamide (3.2 g/m2) | • Annual history and physical examination (for signs and symptoms of anemia and thrombocytopenia) up to 10 y after BMT |
| • Daunorubicin (270 mg/m2) | • Laboratory evaluation (complete blood count with differential, bone marrow biopsy) only if clinically indicated | |
| • Idarubicin (36 mg/m2) | ||
| Subsequent solid malignancies | • TBI (1320 cGy) | • 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 beginning 8 y after radiation or age 25 y (whichever occurs last) | ||
| • Ultrasound and fine needle aspiration (for those with palpable thyroid nodules) |