Table 1.
Hematologic Complications
| Recommendation | Grade | Ref | Comments |
|---|---|---|---|
| • CBC at most routine clinical visits for at least 10 years post-HCT, and as needed | 2A | ||
| • Hemoglobinopathy: chimerism at least every 3 months in year 1 post-HCT and every 6 months in year 2. Further chimerism based on previous results | 2A | ||
| • Regular monitoring of serum ferritin until normalized | 2A | [33,362,363] | • Serum ferritin is a good, albeit nonspecific, initial screening test for iron overload. |
| • Iron quantification by MRI more accurately evaluates iron overload than serum ferritin; recommended to assess liver and cardiac iron levels and follow progress after phlebotomies and/or iron chelation. | 2A | [33,362,363] | • Risk based on prior transfusion history or underlying HCT indication (eg, hemoglobinopathy, Diamond-Blackfan anemia, high-risk leukemia, neuroblastoma) |
| • Post-HCT phlebotomy is the treatment of choice for significant iron overload. | 2A | [33,364,365] | • Iron chelation may be considered in patients ineligible for phlebotomy; prolonged or combined modality treatment may be necessary. • In females, resumption of menstruation (either naturally or via cyclical hormone replacement regimens) may reduce iron burden. |
| • VTE prophylaxis is indicated in patients with multiple myeloma receiving immunomodulatory imide drugs (eg, lenalidomide) and chemotherapy and/or dexamethasone after HCT. | 2B | [366,367] | |
| • Before initiating anticoagulation, the risk of bleeding should be assessed. | 2A | ||
| • Inherited bone marrow failure syndromes require specialized follow up with a multidisciplinary specialist team. | 2A | • Hematologist familiar with the underlying condition, HCT physician, other sub-specialty providers |