Page 1693 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 93 Late Complications of Hematologic Diseases and Their Therapies 1511

TABLE Monitoring for Potential Late Effects—cont’d
93.5
Potential Late Effects Therapeutic Exposure Recommended Monitoring Suggested Interventions
Osteopenia, osteoporosis Corticosteroids Bone-density study (DEXA scan or Calcium and vitamin D supplementation;
Methotrexate (high-dose quantitative CT scan): baseline at entry weight-bearing exercise; treatment of
systemic) into long-term follow-up, repeat as exacerbating conditions (e.g.,
HCT clinically indicated hypogonadism); consider pharmacologic
intervention (e.g., bisphosphonates)
Avascular necrosis Corticosteroids Methotrexate History: yearly; MRI if clinically indicated Orthopedic consultation if indicated
(systemic)
HCT
Scoliosis/kyphosis Irradiation of trunk (e.g., Physical examination of spine: yearly Orthopedic referral
mantle, spine, abdomen, (every 6 months during pubertal growth
pelvis) spurt)
Radiologic imaging of the spine if clinical
evidence of scoliosis or kyphosis
Joint contractures Chronic GVHD related to HCT Physical examination yearly Orthopedic referral if indicated
Chronic infection Chronic GVHD related to HCT History: yearly Prophylactic antiinfective agents;
infectious disease consultation if
indicated
Vitiligo Chronic GVHD related to HCT Physical examination: yearly Dermatology or rehabilitation consultation
Scleroderma Irradiation (any field) Careful physical examination, inspection if clinically indicated
Joint contractures and palpation of irradiated skin and Dermatology or surgical referral and
Nail dysplasia soft tissues: yearly radiographs if indicated for any
Dysplastic nevi suspicious lesions
Skin cancer
Secondary benign or
malignant neoplasms
in radiation field
Bone malignancies Cranial irradiation History and physical examination: yearly Neurosurgical consultation as indicated
Brain tumor Brain MRI: baseline at maturity for all
patients and as clinically indicated
Breast cancer Chest or thorax irradiation Clinical breast examination: yearly until Teach breast self-examination; instruct
≥20 Gy (mantle radiation age 25, then every 6 months patient to perform monthly self-
field) Mammogram and breast MRI: yearly examination and report changes
TBI or chest or thorax beginning at age 25 or 8 years after immediately; surgical consultation if
irradiation 10–19 Gy (mantle irradiation (whichever comes last) clinically indicated
radiation field) Discuss benefits and risks/harms of
screening; if decision is made to
screen, follow above recommendations
Gastrointestinal Abdominal, pelvic, spinal Colonoscopy every 5 years beginning 10 Surgical consultation if indicated
malignancy irradiation ≥30 Gy years after radiation or at age 35,
whichever comes last; or more
frequently as clinically indicated
AML (preceding Anthracyclines Physical examination: yearly for 10 years Counsel patient to report fatigue, bruising,
myelodysplastic phase Epipodophyllotoxins after therapy bleeding, bone pain
associated with Alkylating agents CBC and differential and bone marrow
alkylating agents) Stem cell priming with evaluation if clinically indicated
etoposide
Autologous transplantation for
NHL or Hodgkin lymphoma
AFP, α-Fetoprotein; ALT, alanine aminotransferase; AML, acute myeloid leukemia; AST, aspartate aminotransferase; BMI, body mass index; BP, blood pressure; BUN,
blood urea nitrogen; CBC, complete blood cell count; CT, computed tomography; DEXA, dual-energy x-ray absorptiometry; ECG, electrocardiogram; ECHO,
echocardiogram; FSH, follicle-stimulating hormone; GFR, glomerular filtration rate; GVHD, graft-versus-host disease; HCT, hematopoietic cell transplantation; HCV,
hepatitis C virus; hemoglobin A1c, glycosylated hemoglobin; HIB, Haemophilus influenzae type B; HIV, human immunodeficiency virus; LH, luteinizing hormone; MRI,
magnetic resonance imaging; NHL, non-Hodgkin lymphoma; PCR, polymerase chain reaction; RNA, ribonucleic acid; T 4, thyroxine; TBI, total body irradiation; TSH,
thyroid-stimulating protein.
Modified from Children’s Oncology Group: Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers, version 4.0, 2013, Children’s
Oncology Group. http://www.survivorshipguidelines.org

82
306
treatment summaries, survivorship plans, and efforts to harmo- that can reduce the impact of cancer and treatment-related late effects
307
nize survivorship guidelines worldwide that serve as a model for on quality of life, morbidity, and mortality, as well as to develop and
the survivorship care of adult patients with cancer. It is important test new interventions. For example, survivors of HL who are treated
that more recent cohorts of cancer survivors continue to be followed with chest radiation have an increased risk of developing lung cancer,
to determine how therapy modifications impact the prevalence and and tobacco use increases this risk 20-fold. Successful smoking pre-
spectrum of late effects. It is important to apply known interventions vention and cessation strategies among survivors can decrease the risk