Long-Term Follow-Up

Preventive Maintenance After Transplant

 

Q. Are there special medical tests or preventive measures I need to take because I had a bone marrow or stem cell transplant?

Yes. The treatment you received may put you at a higher risk for certain types of problems. For this reason, we recommend that you have certain medical tests each year (or on a regular schedule) for the rest of your life. We also recommend that you follow basic healthy practices like not using tobacco, limiting alcohol, eating healthy foods, and exercising and using sunscreen regularly.


Q. What types of tests should I have on a regular basis?

We recommend that you have the following tests performed by your health care provider:

Blood tests — Annual complete blood count (CBC), glucose level, lipid levels, liver function tests, renal function, thyroid hormone levels. If you have never been tested for hepatitis C virus, you should have this test done, especially if you had transfusions or a transplant before 1991.

Dental — Maintain good oral health by having routine dental examinations after transplant. If your white blood cell count is normal and if you are not taking immunosuppressive medications, you can resume routine dental cleanings and treatments beginning at 6 months after an autologous transplant or after a transplant from an identical twin, or beginning at 1 year after an allogeneic transplant.

You should avoid routine dental treatment if you had an autologous transplant or identical twin transplant less than 6 months ago, or if you had an allogeneic transplant less than 12 months ago, or if you are taking immunosuppressive medications for treatment of chronic GVHD, since even simple cleanings and fillings can cause infections. This precaution should not prevent you from receiving dental treatment that is medically necessary. If dental treatment is medically necessary, it is very important for you to take antibiotics immediately before the treatment in order to prevent infections, especially if you have chronic GVHD or if you are still taking medicines that suppress the immune system. You must be sure that your dentist knows that you have had a transplant.

You must tell your dentist if you have ever received a bisphosphonate drug (for example, Zometa, Aredia, Fosamax, Actonel, Boniva, etc.). If you have been treated with these drugs to maintain bone density, normal dental treatments such as extractions and periodontal surgery can cause a complication known as osteonecrosis of the jaw, which prevents healing of the bone. The risk for osteonecrosis persists for many years, even after treatment with the bisphosphonate drug has been stopped.

Children who had a transplant before the age of 10 should have a Panoramic dental x-ray taken approximately every year to assess tooth development and eruption.

Eyes — Exam every year to check for cataracts or other problems.

Lungs — Pulmonary function tests one year and five years after transplant, or annually if you have lung problems or are being treated for chronic GVHD.

Bones — Bone density test or DEXA scan at one year after transplant, repeated every year if the initial test shows decreased density. Patients who are taking prednisone should have a DEXA scan every year.

Colon — Annual test for blood in the stool and a colonoscopy at age 50.

Females — Annual Pap smear, breast exam, mammogram (after age 35).

CML patients — Annual blood test for bcr/abl.

Children — Height should be measured every six months. Growth hormone levels should be tested annually until age 16. Pulmonary function tests should be done every year after age 6.

For more information, go to:

LTFU recommendations - adults
LTFU recommendations - children
Late lung problems in children


Q. Do I need to pay special attention to cancer screening after a transplant?

Several factors contribute to an increased risk of cancer in patients who have had a transplant. If you were treated for a malignant disease, there is a risk that the disease could come back. Anyone who has had cancer is also at a higher risk of developing another malignant disease. The transplant and related treatments with chemotherapy and radiation therapy also increase the risk of certain types of cancer. We have seen an increase in the risk of cancers of the skin, mouth, breast, thyroid gland and brain in patients who have had a marrow or blood cell transplant. The risk of liver cancer is increased in patients who have infection with hepatitis C virus. Patients should inform their health care provider that they are at an increased risk for these diseases.

For more information, go to:
Tumor risk
New cancer after transplant
  

Q. What additional preventative measures can I take to avoid problems?

We recommend that all patients follow healthy lifestyle guidelines. Exercise, especially walking and weight-bearing exercise for 20-60 minutes every day to prevent bone loss and build stamina; eating a healthy, balanced diet including at least five daily servings of fruits and vegetables; vitamin and mineral supplements for calcium and vitamin D, to prevent bone loss if your diet doesn't contain at least 1500 mg of calcium and 800 i.u. of vitamin D per day; avoiding exposure to sunlight by wearing a hat, long-sleeves and/or sunscreen; regular hand-washing to avoid illness, especially during cold and flu season.

For more information, go to:
Stay Healthy