TABLE E2.

Follow-up schedule after transplantation

Years 1-5
If possible, the patient should return to the HCT treatment center at least once a year for an evaluation of the patient's immune system. Patients can have autoimmune disease or atypical GVHD during this period. This includes cytopenias, steroid-responsive pneumonitis, and kidney disease, as well as the more typical skin, liver, and gastrointestinal disease. If the patient has recurrent or unusual infections or any manifestation of GVHD, including diarrhea, he or she should be referred back to the treatment center.
Growth and development should be monitored carefully. If the patients received a preparative regimen, endocrine problems, neurocognitive delays, osteopenia, and dental problems can arise.
In general, lineage-specific chimerism should be evaluated approximately every 6 to 12 mo after HCT.
First year	Monthly PE, including blood pressure, and assessment of growth (height, weight, and head circumference) with a growth chart Every 3 mo: complete blood count with differential, lymphocyte phenotype (minimum: T, B, NK, CD4+CD45RA+, CD8) and function (minimum PHA), and serum immunoglobulin measurement
	Six and 12 mo: LFTs, chemistry 7 metabolic test panel, clinical pulmonary assessment, urinalysis, and PFTs (if too young, pulse oximetry with 6-minute walk). If any chronic pulmonary symptoms, abnormal PFTs, or abnormal chest computed tomographic scan, refer to pediatric pulmonologist, if possible.
	12 mo: Dental, ophthalmologic, chest radiograph (if abnormal, computed tomographic scan), thyroid function, and echocardiogram
Second year	Every 3 mo: PE, assessment of growth, and lymphocyte phenotype and function
	24 mo: dental, ophthalmology, chest radiograph (if abnormal, computed tomographic scan of the chest and sinuses), thyroid function, and neurocognitive testing
Years >2	If off immunoglobulin replacement and normal T-cell function, yearly PE, assessment of growth, lymphocyte phenotype and function, and immunoglobulin measurement
	If on IVIG, PHA <50% of normal value, or both, same as above, but every 6 mo; yearly chest radiograph if with respiratory tract infections (if abnormal, computed tomographic scan of the chest and sinus)
	All patients: yearly dental, ophthalmology, endocrine, PFTs (if too young, pulse oximetry with 6-minute walk)
Follow-up after 5 y
If possible, the patient should return to the treatment center at least once every 2 years. The treatment center will continue to monitor immune reconstitution and chimerism. The medical problems that are described above, growth failure, endocrine dysfunction, neurocognitive problems, and dental problems, can persist or develop. In addition, some patients have intractable warts. Secondary malignancies should be considered. When the patient reaches adolescence, genetic counseling should be offered.

IVIG, Intravenous immunoglobulin; LFT, liver function test; PE, physical examination; PFT, pulmonary function test.