Table 4.

CIBMTR/EBMT screening guidelines and preventive practice recommendations for metabolic syndrome and cardiovascular risk factors for adult and pediatric patients amongst the general population and HCT survivors

	Screening guidelines	Preventive practice
Weight, Height, BMI	Weight, height, and BMI assessment at every clinic visit (at least yearly) Waist circumference measurement yearly Consider DXA to assess sarcopenia	Provide advice regarding intensive, multicomponent behavioral interventions focused on achieving and maintaining healthy weight by reducing caloric intake and increasing physical activity
Dyslipidemia	For all allo-HCT recipientes, initial lipid profile 3 months after HCT. For high-risk patients with ongoing risk factors (including those on sirolimus, calcineurin inhibitors, corticosteroids), repeat evaluation every 3–6 months. For standard-risk patients, lipid profile assessment every 5 years in males aged ≥35 years and females aged ≥45 years. The interval for screening should be shorter for people who have lipid levels close to those warranting therapy.	Lifestyle modifications and lipid lowering therapies to achieve relative reductions in LDL is the primary goal In adults, the decision to initiate lipid lowering therapy should include assessment of overall risk of heart disease (http://cvdrisk.nhlbi.nih.gov). If TG>500 mg/dL (5.65 mmol/L), initiate fibrate or nicotinic acid
Blood Pressure	Blood pressure assessment at every clinic visit (at least yearly)	Non-pharmacologic treatments may also be tried for mild hypertension and include moderate dietary sodium restriction, weight reduction in the obese, avoidance of excess alcohol intake, and regular aerobic exercise. Treatment is indicated for readings >140/90 in adults on two separate visits at least 1 week apart, unless hypertension is mild or can be attributed to a temporary condition or medication (eg, cyclosporine).
Hyperglycemia	For high-risk patients with ongoing risk factors (including those on systemic corticosteroids), screen for abnormal blood glucose (HbA1C or fasting plasma glucose) 3 months after HCT with repeat evaluation every 3–6 months. For standard-risk adult patients, screening for abnormal blood glucose every 3 years in adults aged ≥45 years or in those with sustained higher blood pressure (>135/80 mm Hg) For standard-risk pediatric patients, fasting glucose at least every 5 years; if abnormal, screen annually	For IFG, encourage weight reduction and increased physical activity. For type 2 DM, lifestyle therapy, and pharmacotherapy, if necessary, should be used to achieve near-normal HbA1C (<7%).

Abbreviations:

BMI: body mass index; CIBMTR: Center for International Blood and Marrow Transplant Research; DM: diabetes mellitus; DXA: dual X-ray absorptiometry; EBMT: European Group for Blood and Marrow Transplantation; HbA1C: hemoglobin A1C; HCT: hematopoietic cell transplantation; IFG: impaired fasting glucose; LDL: low-density lipoprotein; TG: triglycerides