Risk-based anticipator screening
| Cause of nonrelapse late mortality . | Populations at highest risk . | Recommended interventions to reduce mortality . |
|---|---|---|
| Infection | ||
| Hepatitis C | • Active chronic GVHD | • Aggressive surveillance for, and appropriate management: fevers, respiratory/sinus infections, etc |
| Bacterial sepsis | • On immunosuppressive therapy | • Viral/bacterial prophylaxis per institutional policy |
| Fungal infections | • BMT <1990 | |
| Viral infections | ||
| Subsequent neoplasms | ||
| Oropharyngeal cancers | • Chronic GVHD | • Careful oral examination |
| • Human papillomavirus infection | • High index of suspicion, with referral to otolaryngologist | |
| • Tobacco, alcohol | ||
| Esophageal cancer | • Chronic GVHD | • High index of suspicion for patients with dysphagia, unintended weight loss–to initiate further workup |
| • TBI | ||
| Colorectal cancer | • TBI | • Colonoscopy as per US Preventive Services Task Force or American Cancer Society guidelines |
| Brain tumors | • TBI | • High index of suspicion for further workup |
| Hepatocellular carcinoma | • Chronic hepatitis B or hepatitis C infection | • High index of suspicion for further workup |
| • Chronic GVHD | ||
| Cardiovascular disease | ||
| Cardiomyopathy | • Prior exposure to anthracycline chemotherapy, chest radiation, neck radiation | • Aggressive management of diabetes, hypertension, and dyslipidemia |
| Coronary artery disease | • Presence of diabetes, hypertension, dyslipidemia | • Periodic screening for cardiomyopathy, coronary artery disease carotid artery stenosis (among those at high risk) |
| Stroke |
| Cause of nonrelapse late mortality . | Populations at highest risk . | Recommended interventions to reduce mortality . |
|---|---|---|
| Infection | ||
| Hepatitis C | • Active chronic GVHD | • Aggressive surveillance for, and appropriate management: fevers, respiratory/sinus infections, etc |
| Bacterial sepsis | • On immunosuppressive therapy | • Viral/bacterial prophylaxis per institutional policy |
| Fungal infections | • BMT <1990 | |
| Viral infections | ||
| Subsequent neoplasms | ||
| Oropharyngeal cancers | • Chronic GVHD | • Careful oral examination |
| • Human papillomavirus infection | • High index of suspicion, with referral to otolaryngologist | |
| • Tobacco, alcohol | ||
| Esophageal cancer | • Chronic GVHD | • High index of suspicion for patients with dysphagia, unintended weight loss–to initiate further workup |
| • TBI | ||
| Colorectal cancer | • TBI | • Colonoscopy as per US Preventive Services Task Force or American Cancer Society guidelines |
| Brain tumors | • TBI | • High index of suspicion for further workup |
| Hepatocellular carcinoma | • Chronic hepatitis B or hepatitis C infection | • High index of suspicion for further workup |
| • Chronic GVHD | ||
| Cardiovascular disease | ||
| Cardiomyopathy | • Prior exposure to anthracycline chemotherapy, chest radiation, neck radiation | • Aggressive management of diabetes, hypertension, and dyslipidemia |
| Coronary artery disease | • Presence of diabetes, hypertension, dyslipidemia | • Periodic screening for cardiomyopathy, coronary artery disease carotid artery stenosis (among those at high risk) |
| Stroke |