ASBMT Practice Guidelines Committee Survey on Long-Term Follow-Up Clinics for Hematopoietic Cell Transplant Survivors

Abstract

Significant advances in hematopoietic cell transplantation (HCT) have increased the long-term survivorship of its recipients, but because of unique complications arising from radiation and chemotherapy, recipients require lifelong follow-up. To evaluate current survivorship or long-term follow-up (LTFU) clinics specifically for HCT survivors and to evaluate the potential barriers in their establishment, the American Society for Blood and Marrow Transplantation (ASBMT) Practice Guidelines Committee electronically surveyed 200 HCT programs to gather quantitative and qualitative data about models of care. Among 77 programs (38.5%) that responded, 45% indicated presence of an LTFU clinic; however, LTFU care models varied with respect to services provided, specialist availability, type of patients served, and staffing. Among 55% of programs without an LTFU clinic, 100% agreed that allogeneic HCT survivors have unique needs separate from graft-versus-host disease and that complications could arise during the transition of care either from pediatric to adult settings or away from the HCT center. Lack of expertise, logistics, financial issues, and the observation that 84% of individual practitioners prefer to provide survivorship care were the identified obstacles to establishing new LTFU clinics. The ASBMT hopes that policymakers, HCT providers, and institutions will benefit from the results of this survey and recommends that delivering guidelines-driven screening and expert management of late effects is the goal of first-rate HCT survivorship care.

Transplant center characteristics and survival after allogeneic hematopoietic cell transplantation in adults

“…43,44 Centers can use guidelines for long-term followup and tools such as treatment summary and survivorship care plans to establish a foundation for coordinated patient-centric survivorship care. [44][45][46][47][48] Our study has the limitations of an observational registry based analysis. In addition, we did not take into account autologous HCT experience and volumes, since reporting of autologous HCT activity is voluntary and is not included in the annual center survival analysis.…”

Early Prediction of Cardiovascular Risk after Hematopoietic Cell Transplantation: Are We There Yet?

“…Table 4 summarizes recommendations for clinical practice and research in this field. Given the heterogeneity of long-term follow-up care [101], long-term efforts are warranted to incorporate CV risk prediction in everyday clinical practice by a multidisciplinary approach involving teamwork by hematologists, internists, and cardiologists.…”

Current Status and Needs of Long-Term Follow-Up Clinics for Hematopoietic Cell Transplantation Survivors: Results of a Nationwide Survey in Japan

“…With a growing number of patients surviving long term after transplantation, more attention is being given to the importance of survivorship clinics. Although guidelines on screening and preventive practices in transplantation survivors have been published [10], there remains a need for more practical strategies regarding staffing capacity, establishing LTFU clinics, and designating responsibility for delivering latephase preventive services [14,15]. To clarify these issues, we characterized the current operation of LTFU clinics in Japan by conducting a nationwide survey targeting HCT centers.…”