Pediatric-Specific Screening and Prevention Post HCT

Pediatric hematopoietic cell transplant (HCT) patients have unique post-transplant screening needs caused by pre-transplantation conditioning including total body irradiation (TBI) and chemotherapy.

In addition to screening recommendations for all HCT recipients, pediatric patients have special considerations for the nervous system, endocrine system and oral health. [1]
View Long-Term Care Guidelines (PDF).

Nervous System

Children exposed to TBI are also at risk for developmental delays. Evaluation for cognitive developmental milestones should be performed at least annually in pediatric patients.

Endocrine System

Growth retardation is frequent in transplanted pediatric patients receiving TBI and many children receiving transplants will have markedly reduced growth rates for two years post-transplant. Similarly, growth hormone deficiency is also common.
Hypothyroidism can occur in patients receiving irradiation to the head. Transplant recipients with hypothyroidism should receive thyroxine. [2]

Oral Health

In pediatric transplant patients, there is the potential for radiation to interfere with the development of the teeth and face. Underdevelopment of the mandible is of particular concern. Changes in dental and facial development are most severe in children under the age of seven when transplanted. Annual oral evaluation for tooth development is recommended.

Post-Transplant Care Guidelines

We offer guidelines for evaluations at 6 months and 12 months after transplant, then annually thereafter. Specific measures for pediatric patients are included.

Access HCT Guidelines for Clinicians

• Access interactive tool  for a customizable list of screening recommendations
• Download Post-HCT Care Guidelines (PDF)
• Order print version or download the HCT Guidelines mobile app

Access Patient Post-Transplant Care Guidelines

• Post-bone marrow transplant guidelines

Children's Oncology Group Guidelines

The Children's Oncology Group (COG) has developed Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, which are available at survivorshipguidelines.org. They include recommended long-term care for recipients of autologous or allogeneic HCT for malignant and non-malignant diseases, organized by organ systems that include accompanying evidence grades. An overview of the COG guidelines focusing on the long-term care of transplant recipients has also been published in Biology of Blood and Marrow Transplantation. [3]

References

1. Majhail NS, Rizzo JD, Lee SJ, et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation; Center for International Blood and Marrow Transplant Research (CIBMTR), American Society for Blood and Marrow Transplantation (ASBMT), European Group for Blood and Marrow Transplantation (EBMT), Asia-Pacific Blood and Marrow Transplantation Group (APBMT), Bone Marrow Transplant Society of Australia and New Zealand (BMTSANZ), East Mediterranean Blood and Marrow Transplantation Group (EMBMT) and Sociedade Brasileira de Transplante de Medula Ossea (SBTMO). Co-published in Biol Blood Marrow Transplant, 2012, 18(3): 348-371; Bone Marrow Transplant, 2012, 47(3): 337-341; and Hematol Oncol Stem Cell Ther, 2012, 5(1): 1-30. Access
2. Sanders JE. Growth and development after hematopoietic cell transplant in children. Bone Marrow Transplant. 2008; 41(2): 223-227. Access
3. Chow EJ, Anderson L, Baker KS, et al. Late effects surveillance recommendations among survivors of childhood hematopoietic cell transplantation: A Children's Oncology Group Report. Biol Blood Marrow Transplant. 2016; 22(5): 782-795. Access