{"entity":{"id":"rejuv-tx-what-to-ask-for","kind":"technology","name":"After a transplant or cell therapy: what to ask for","aka":["transplant survivorship checklist","questions after transplant","post-transplant follow-up checklist"],"tldr":"The things worth asking a transplant team for, in one place: who follows you up and for how long, which screens are due at which year, what immunisations you need and when, and who to ring when something changes.","summary":"A written revaccination schedule. The single most useful item. A transplant removes the protection from a lifetime of vaccination; published schedules exist to rebuild it, the vaccines are free at the point of use in the NHS, and the usual failure is that neither the transplant centre nor general practice owns the plan. Ask who owns it and ask for it on paper. If you are receiving immunoglobulin replacement, the two schedules need coordinating.\n\nA survivorship care plan. What you had, in what doses, what the specific risks are, which tests are due and at what interval, and who to contact. The international screening recommendations are the template.\n\nSpirometry on a schedule. Bronchiolitis obliterans syndrome after an allogeneic transplant is silent until a great deal of lung function has gone and nothing recovers it once the airways have scarred. Breathing tests find it while it can still be slowed.\n\nA ferritin, after the first year. Transfusional iron loading is common, it is measured by a cheap blood test, and once the graft is working it can be removed by venesection.\n\nA bone density scan, and an MRI if a hip hurts. Bone loss is fastest in the first year and corticosteroids drive it. Avascular necrosis does not show on an early plain radiograph, so hip or groin pain on weight-bearing after steroid exposure needs an MRI rather than reassurance.\n\nAn eye test, and a named ophthalmologist if there is ocular GvHD. Cataract after total body irradiation is common and is corrected by surgery. Ocular GvHD needs more than artificial tears, and a general dry eye clinic may not reach for serum drops or scleral lenses.\n\nThyroid, lipids, glucose and blood pressure. Conventional cardiovascular risk factors keep their full predictive power in transplant survivors and add to the treatment-related risk, so they are worth treating here at least as hard as in anyone else. Body mass index will not show the change in body composition; the blood tests will.\n\nA skin and mouth examination, every year. Second cancers after allogeneic transplant run at about twice the expected rate, rising to about threefold by fifteen years, and the excess is concentrated in squamous cancers of skin and mouth in people with chronic GvHD. Sun protection and not smoking do more here than almost anywhere else.\n\nA conversation about fertility, before conditioning, not after. Everything that preserves fertility happens before treatment starts. If treatment has already happened, ask about hormone replacement, which treats the bone and cardiovascular consequences of gonadal failure as well as the symptoms.\n\nA genital examination, and permission to raise sexual function. Genital chronic GvHD is the manifestation most often missed, because it is rarely examined for unless asked about.\n\nPsychological support, without having to justify it. Nearly half of long-term CAR-T survivors in the best study reported at least one clinically meaningful cognitive, anxiety or depressive difficulty, and prior anxiety or depression was the strongest predictor.\n\nIf you had a gene-modified cell product, stay in the long-term follow-up. Fifteen years is the recommended duration for integrating vectors. It is a long time and it is the only way the late safety question gets answered, for you and for the people treated after you.\n\nAnd one thing not to do. Nothing sold as an immune-boosting or regenerative infusion, injection or supplement has been shown to speed immune reconstitution or reverse any late effect on this page. The frontier records elsewhere on this front grade those claims one by one. The items above are the ones with evidence, and they are free or nearly free.","status":"standard-of-care","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transplantation","links":[{"label":"Majhail et al., Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation (Biol Blood Marrow Transplant 2012)","url":"https://doi.org/10.1016/j.bbmt.2011.12.519"},{"label":"Cordonnier et al., Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia, ECIL 7 (Lancet Infect Dis 2019)","url":"https://doi.org/10.1016/S1473-3099(18)30600-5"},{"label":"Miller et al., Joint consensus statement on the vaccination of adult and paediatric haematopoietic stem cell transplant recipients, on behalf of BSBMTCT, CCLG and the British Infection Association (J Infect 2023)","url":"https://doi.org/10.1016/j.jinf.2022.11.005"},{"label":"Rizzo et al., Solid cancers after allogeneic hematopoietic cell transplantation (Blood 2009)","url":"https://doi.org/10.1182/blood-2008-05-158782"},{"label":"Inamoto and Lee, Late effects of blood and marrow transplantation (Haematologica 2017)","url":"https://doi.org/10.3324/haematol.2016.150250"},{"label":"FDA guidance for industry: long term follow-up after administration of human gene therapy products (January 2020)","url":"https://www.fda.gov/regulatory-information/search-fda-guidance-documents/long-term-follow-after-administration-human-gene-therapy-products"}],"tags":["rejuvenation","survivorship","transplant","evidence:strong","follow-up","summary"],"related":["gvhd-chronic-overview","gvhd-nih-consensus-criteria","gvhd-organ-by-organ","gvhd-lung-bronchiolitis-obliterans","gvhd-prophylaxis","gvhd-ruxolitinib-steroid-refractory","gvhd-belumosudil-axatilimab-ibrutinib","gvhd-photopheresis","rejuv-tx-late-effects-overview","rejuv-tx-survival-after-transplant","rejuv-tx-second-cancers","rejuv-tx-iron-overload","rejuv-tx-bone-eyes-kidneys-lungs","rejuv-tx-endocrine-and-cardiometabolic","rejuv-tx-immune-reconstitution-timeline","rejuv-tx-b-cell-aplasia-and-immunoglobulin","rejuv-tx-infection-by-phase","rejuv-tx-revaccination","rejuv-tx-prolonged-cytopenias","rejuv-tx-icans-and-neurocognition","rejuv-tx-secondary-t-cell-malignancy","rejuv-tx-gene-modified-follow-up","rejuv-tx-long-term-follow-up-frameworks","rejuv-tx-fertility-and-growth","rejuv-tx-quality-of-life","rejuv-frontier-immune-reconstitution","rejuv-frontier-what-works"],"cancers":[],"sections":["rejuvenation","supportive-care"],"technologies":["allogeneic-hsct","autologous-stem-cell-transplant","car-t","survivorship-care-plan","fertility-preservation"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects","gvhd","quality-of-life","secondary-malignancy","hypogammaglobulinaemia"],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"The late effects of transplant and cell therapy are numerous, individually uncommon and spread across many specialties, so no single clinician encounters enough of any one of them to catch it reliably by pattern recognition. Surveillance therefore has to be scheduled rather than reactive, and the schedule has to be held by someone. Giving the schedule to the person it concerns is the most robust available arrangement, because they are the only participant guaranteed to be present at every stage.","strengths":["Every item is in a published recommendation or guideline and can be asked for by name","Almost all of it is cheap: blood tests, spirometry, an eye test, an examination","The highest-value item, revaccination, is free at the point of use in the NHS","A written plan held by the patient survives changes of clinician, centre and country"],"limitations":["No randomised evidence that any particular surveillance interval improves outcomes after transplant","Asking requires knowing what to ask for, which is itself unequally distributed","Several items need a specialist who may not be local","A plan is not care: someone still has to do the tests and act on them"]},"route":"/technologies/rejuv-tx-what-to-ask-for/","neighbours":{"technology":[{"id":"gvhd-belumosudil-axatilimab-ibrutinib","kind":"technology","name":"After ruxolitinib: belumosudil, axatilimab and ibrutinib in chronic GvHD","route":"/technologies/gvhd-belumosudil-axatilimab-ibrutinib/"},{"id":"allogeneic-hsct","kind":"technology","name":"Allogeneic stem cell transplantation","route":"/technologies/allogeneic-hsct/"},{"id":"autologous-stem-cell-transplant","kind":"technology","name":"Autologous stem cell transplant (high-dose therapy)","route":"/technologies/autologous-stem-cell-transplant/"},{"id":"rejuv-tx-b-cell-aplasia-and-immunoglobulin","kind":"technology","name":"B-cell aplasia and low antibodies after CAR-T and bispecifics, and immunoglobulin replacement","route":"/technologies/rejuv-tx-b-cell-aplasia-and-immunoglobulin/"},{"id":"rejuv-tx-prolonged-cytopenias","kind":"technology","name":"Blood counts that do not come back after CAR-T: 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costs","route":"/technologies/rejuv-tx-fertility-and-growth/"},{"id":"rejuv-tx-endocrine-and-cardiometabolic","kind":"technology","name":"Hormones, metabolism and the heart after transplant","route":"/technologies/rejuv-tx-endocrine-and-cardiometabolic/"},{"id":"gvhd-nih-consensus-criteria","kind":"technology","name":"How chronic GvHD is diagnosed and scored: the NIH consensus criteria","route":"/technologies/gvhd-nih-consensus-criteria/"},{"id":"rejuv-tx-icans-and-neurocognition","kind":"technology","name":"ICANS, and whether thinking recovers after CAR-T","route":"/technologies/rejuv-tx-icans-and-neurocognition/"},{"id":"rejuv-tx-infection-by-phase","kind":"technology","name":"Infection risk after transplant and cell therapy, phase by phase, and the prophylaxis that follows it","route":"/technologies/rejuv-tx-infection-by-phase/"},{"id":"rejuv-tx-iron-overload","kind":"technology","name":"Iron overload after 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the population","route":"/technologies/rejuv-tx-survival-after-transplant/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"gvhd-lung-bronchiolitis-obliterans","kind":"technology","name":"The lungs after transplant: bronchiolitis obliterans syndrome","route":"/technologies/gvhd-lung-bronchiolitis-obliterans/"},{"id":"rejuv-frontier-what-works","kind":"technology","name":"What actually works after treatment","route":"/technologies/rejuv-frontier-what-works/"},{"id":"gvhd-ruxolitinib-steroid-refractory","kind":"technology","name":"When steroids fail: ruxolitinib for steroid-refractory GvHD","route":"/technologies/gvhd-ruxolitinib-steroid-refractory/"},{"id":"rejuv-tx-long-term-follow-up-frameworks","kind":"technology","name":"Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered","route":"/technologies/rejuv-tx-long-term-follow-up-frameworks/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"term":[{"id":"gvhd","kind":"term","name":"Graft-versus-host disease (GVHD) and graft-versus-leukaemia","route":"/terms/gvhd/"},{"id":"hypogammaglobulinaemia","kind":"term","name":"Hypogammaglobulinaemia and infection risk after B-cell therapies","route":"/terms/hypogammaglobulinaemia/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"},{"id":"secondary-malignancy","kind":"term","name":"Secondary malignancy (therapy-related cancer)","route":"/terms/secondary-malignancy/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}