Table 2.
Summary of Monitoring Recommendations*
| Parameter | Minimum Frequency (mo) During Systemic Immunosuppressive Therapy |
|---|---|
| Interval history with symptom assessment (including psychosocial symptoms) and medication review | 3 |
| Physical examination (by healthcare provider) | |
| General | 3 |
| Photographic ROM | 3–6 |
| Skin surveillance for secondary malignancy | 6–12 |
| Weight: | |
| Adults | 3 |
| Children | 1–3 |
| Height: | |
| Adults | 12 |
| Children | 3–6 |
| Nutritional assessment† | |
| Adults | 3–6 |
| Children | 1–6 |
| Tanner score (children and adolescents) | 6–12 |
| Developmental assessment (children and adolescents) | 3–6 |
| Laboratory monitoring | |
| Complete blood counts with differential | 3 |
| Chemistry panel including renal and liver function tests | 3 |
| Therapeutic drug monitoring | 3 |
| IgG level (until normal and independent of replacement) | 1–3‡ |
| Lipid profile (during treatment with corticosteroids or sirolimus). | 6 |
| Iron indices (if red cell transfusions are required or if iron overload has been documented previously) | 6–12 |
| Pulmonary function tests (PFT) | 3–6 |
| Endocrine function evaluation, eg, thyroid function tests, bone densitometry (if an abnormal result might change clinical management), calcium levels, 25-OH vitamin D | 12 |
| Subspecialty evaluations | |
| Ophthalmology | 3–12 |
| Dental assessment and oral cancer surveillance, including soft and hard tissues examination (radiographs as indicated); culture, biopsy or photographs of lesions (as clinically indicated); and professional dental hygiene. | 6 |
| Dermatology with assessment of extent and type of skin involvement, biopsy, or photographs (as clinically indicated). | 12* |
| Gynecology for vulvovaginal involvement (as clinically indicated). | 3–12 |
| Physiotherapy with assessment of ROM (if joint limitation is present). | 3–12 |
| Neuropsychological testing (as clinically indicated). | 12 |
All organ systems should be monitored at least annually and after immunosuppressive therapy is completed during extended survivorship [1,2]. The scope and frequency of monitoring should be individualized as clinically indicated. More frequent monitoring is strongly advised for those with active GVHD, especially during high-risk periods (eg, treatment taper or escalation).
Could be screened by health care provider and referred to nutritionist, if indicated.
Context dependent because post-transplantation immunoglobulin replacement during chronic GVHD therapy is not routine after the first post-transplantation year except when there are recurrent sinopulmonary infections or HCT for underlying primary immunodeficiency disease. See Table 11.