1 Introduction

Patients undergoing HCT (mainly allo-HCT) have a risk of developing complications related to pre-, peri-, and post-HCT. The resulting morbidity of the HCT process makes it necessary for patients to adopt a healthy lifestyle that promotes health and contemplate preventive measures for the detection and treatment of possible complications.

The short- and long-term controls allow for regular and systematic screening and at the same time are an opportunity to give advice on healthy lifestyle habits. Monitoring should be multidisciplinary with involvement of hematology, other medical specialties, physicians of primary care, nursing, and mental health professionals.

Early and late complications, as well as psychological problems, are discussed in Parts IV, V, and VI of the Handbook.

After discharge, a long-term follow-up plan for each patient is needed which takes the given treatment and individual risk factors into account.

The recommendations related to screening and prevention post-HCT can be consulted in several web pages (see References).

2 Monitoring Depending on the Type of HCT

2.1 Autologous HCT

Timing

Monitoring

From discharge to day +100

Until full hematologic recovery, it is recommended to live near the hospital

Recommended controlsa:

 – Clinical evaluation and transfusions when necessary

 – Basic hematological and biochemical tests

 – Specific markers for different diseases

At +3 months

Evaluate the status of the primary disease

Recommended controlsa:

 – Hematological and biochemical tests, specific tumoral markers

 – MRD evaluation: Immunophenotype and molecular specific adapted to each disease

 – BM biopsy in case of NHL, HL, MPS, and solid neoplasms with previous marrow affectation, in the remaining disease BM smears (see specific chapters)

 – Imaging tests depending on primary disease

Long term

Visits every 6 months up to 2 years and then annually

Recommended controlsa:

 – Analytical and complementary explorations: See Table 22.1

 – Baseline disease: Control of possible progression or relapse during at least 5 years

 – In patients treated with chemotherapy + radiotherapy, assess the risk of second malignancies or MDS after HCT

  1. aVariable frequency depending on the patient’s condition

2.2 Allogeneic HCT

Timing

Monitoring

From discharge to day +100

It is recommended that the patient resides near the transplant center during the first 3–6 months after HCT

Recommended controlsa:

 – Weekly clinical evaluation, during the first month, every other week until second month, every 2 weeks until third month, and then monthly up to 6–12 m, unless problems arise. It must include complete physical examination, with special emphasis on data of acute GvHD, infections, and pulmonary complications

 – Blood samples: Complete blood count, liver and kidney function, Mg, levels of IS agents, quantify CMV by PCR (and EBV if ATG); chimerism evaluation at 1 and 2 month

 – BM aspirate (or biopsy) in diseases with previous marrow affectation (usually within 1 month of HCT)

At 3 months

Usually, this moment marks the turning point so that, if the patient does not have major problems, he/she can be monitored by the referring doctor. However, the patient should be periodically reevaluated at the transplant center (every 3–4 months during the first year, every 4–6 months during the second year, and annually after the third year)

Recommended controlsa:

 – Visit and complete physical exploration with special emphasis on the signs of acute and chronic GvHD (assessment by organs as indicated in Chaps. 43 and 44 and paragraph 22.3)

 – Blood test: Complete blood count, kidney function, liver function, clearance creatinine, IS levels; chimerism and sample for MRD follow-up. In patients aged <17 years, weight and height every 3 months

Long term

It depends on the complications that arise during follow-up. If there are no complications, it is recommended that a patient visits to the center every 6 months up to 3 years and annually thereafter

Recommended controls:

 – Visit and complete physical examination including gynecological evaluation and endocrinological, if appropriate

 – Analytical and complementary explorations: See sect. 22.3

 – Specific controls: Specific MRD studies on diseases with markers (see corresponding chapters)

 – In patients treated with chemotherapy + radiotherapy, the risk of secondary neoplasms

  1. aVariable frequency depending on the patient’s condition (every 4–6 weeks)

3 Organ-Specific Long-Term Monitoring

Table 22.1 analyzes organ by organ the long-term follow-up recommendations.

Table 22.1 Organ-specific monitoringa
Full size table

4 Fertility (See Chap. 56)

5 Quality of Life (See Chap. 34)

Key Points

  • Patients auto- and mainly allo-HCT have a risk of developing complications related to pre-, peri-, and post-HCT.

  • The resulting morbidity of the HCT process makes it necessary for patients to adopt a healthy lifestyle that promotes health and contemplate preventive measures for the detection and treatment of possible complications.

  • The short- and long-term controls allow for regular and systematic screening and at the same time are an opportunity to give advice on healthy lifestyle habits. These recommendations can be based on comorbidity and individual risk factors.

  • Monitoring should be multidisciplinary with involvement of hematology, other medical specialties, physicians of primary care, nursing, and mental health professionals.