Individualised Follow-Up for Patients after Haematopoietic Stem Cell Transplantation (HSCT) and Treatment for Relapse of Cancer

Introduction: Patients treated with HSCT or for relapse of cancer are at high risk to develop late effects. In order to optimise follow-up in these patients and prevent unnecessary examinations, individualised follow-up recommendations are necessary.

Methods: Using follow-up recommendations of the GPOH treatment protocols, of European and American haematological societies and published data on treatment related late effects, individualised, risk based, exposure-related follow-up recommendations are to be generated. These recommendations will be based on the underlying disease, disease specific risks, treatment given before HSCT and at HSCT, complications after HSCT and their treatment, especially for chronic graft versus host disease and possible interactions leading to an increase in risk. Recommendations for patients with relapse of cancer will be generated correspondingly. Approximately 350 HSCTs are performed in Germany every year, 70% of which are allogeneic. The highest number of patients treated with HSCT are patients with an ALL (30%), followed by immunodeficiencies (12%), neuroblastoma (8%), AML (7%), aplastic anaemia (6%), ewing sarcoma (6%) and MDS/MPS (5%).

Individualised follow-up recommendations will be generated from 1 year after HSCT up 10 years or up to age 18 years. Transition to adult healthcare may also be facilitated with recommendations for life long follow-up.

Conclusions: Individualised, risk based, exposure-related follow-up will optimise long-term follow-up in a group of heavily treated patients with a high risk of developing late complications. This approach will reduce unnecessary examinations and will therefore optimally use the resources of the late effects clinics. In addition, it will help to analyse the occurrence of late complications in patient groups and therefore enable us to further increase the quality of follow-up care.