Table 5

 Bone marrow transplant follow up protocol

BMD, bone marrow density; BMI, body mass index; DEXA, dual energy x ray absorptiometry; ECG, electrocardiogram; FS, fractional shortening; FSH, follicle stimulating hormone; GTT, glucose tolerance test; LH, luteinising hormone; LV, left ventricle; MRI, magnetic resonance imaging; PTH, parathyroid hormone; TSH, thyroid stimulating hormone; USS, ultrasound scanning.
Auxology including sitting height3–6 monthly
Plot BMI
Bone ageAnnually
Discussion pointsSchooling/employment—statementing?
Psychology assessment
Eyes and mouth—?Sicca syndrome
(Consider faecal elastase/trial of Creon if loose stools/poor weight gain)
Hip pain/knee pain: consider MRI—?osteonecrosis
Fertility—if relevant/appropriate age
Special points on examinationPubertal assessment at each visit (testicular volume not a useful indicator of pubertal progression)
Palpation of thyroid
Check moles
Neurological examination
Fundoscopy (cataracts)
Blood pressure
EchocardiogramAll patients who have had anthracyclines
Echocardiogram at end of treatment
(Request FS, LV function, septal motility)
ECG annually (QT interval)
3 yearly if FS ⩾30%, annually if <30%
Growth hormone statusEvaluate if persistent poor growth
Glucose:insulin ratioAnnually—as increased risk of metabolic syndrome
GTT if abnormal
LipidsFasting lipids annually
Thyroid functionT4 and TSH annually
Replace thyroxine if TSH persistently elevated
GonadotrophinsLH, FSH, oestradiol/testosterone annually after 10 years of age
Consider pelvic USS in females; uterine size, endometrial thickness, Doppler studies
Semen studies in males as requested by patient
Ovarian failure may be reversible—trial off oestrogen for 6–8 weeks every 2 years recommended
Evaluation of BMDAnnual PTH and vitamin D
DEXA at 2 years, then 3 yearly if concern (must correct for size)