Table 2.
Recommended assessment of cardiac, pulmonary, renal, and gonadal functions
| Assessment | Interval | |
|---|---|---|
| Lungs | ||
| Clinical | PFTs: FEV1, FVC, TLC, and DLCO | Before intervention, 6 months, 12 months, yearly thereafter for 5 years, and beyond 5 years if abnormality detected/persists |
| PFT changes in the presence of cGVHD or infections | ||
| Research | PFT changes in the presence of external variables/environmental pathogens such as smoking, vaping, and reactive airway disease | Will require assessment at more frequent intervals |
| Heart | ||
| Clinical | Echocardiogram including LVEF, SF, and TRJV | Before intervention, 6 months, 12 months, yearly thereafter for 5 years, and beyond 5 years if abnormality detected/persists |
| Research | 6-minute walk test | Before intervention, yearly for 2 years, every alternate year thereafter. |
| NT-proBNP | Continue beyond 5 years if abnormality detected/persists | |
| CMRi | ||
| Kidneys | ||
| Clinical | BUN, creatinine, electrolytes, GFR, or 24-hour creatinine clearance | Before intervention |
| Urine analysis for blood/protein | Annually until nephrotoxic medications discontinued. | |
| Microalbuminuria (albumin-to-creatinine ratio) | Continue to monitor every 2 years and beyond due to chronic nature of disease | |
| Blood Pressure | ||
| Research | Renal injury biomarkers such as urinary KIM-1, NGAL, MCP-1, and urine elafin | Before and after intervention; and at least every 1-2 years after HCT or GT |
| Ovaries | ||
| Clinical | AMH, LH, estradiol, and FSH | Before intervention and then yearly, based on age |
| Pubertal changes | Intervention: estrogen supplementation | |
| Premature ovarian insufficiency | ||
| Oocyte cryopreservation | Per patient preference | |
| Ovarian tissue cryopreservation for implantation | Per patient preference | |
| Testicles | ||
| Clinical | FSH, LH, and testosterone | Before intervention and then yearly, based on age |
| Pubertal changes | Semen analysis if applicable | Per patient preference |
| Sperm cryopreservation | Intervention such as testosterone supplementation | |
| Research | Testicular tissue implantation | Per patient preference |
| Testicular tissue cryopreservation |
AMH, anti-Müllerian hormone; BUN, blood urea nitrogen; cGVHD, chronic GVHD; CMRi, cardiac MRI; DLCO, diffusion capacity of the lungs for carbon monoxide; FEV1, forced expiratory volume in 1 second; FSH, follicle-stimulating hormone; FVC, forced vital capacity; GFR, glomerular filtration rate; GT, gene therapy; KIM-1, Kidney Injury Molecule-1; LH, luteinizing hormone; LVEF, left ventricular ejection fraction; MCP-1, monocyte chemoattractant protein-1; NGAL, neutrophil gelatinase-associated lipocalin; NT-proBNP, N-terminal pro B-type natriuretic peptide; PFT, pulmonary function tests; SF, shortening fraction; TLC, total lung capacity; TRJV, TRJ velocity.