II. Indications

  1. Leukemia management
  2. Bone Marrow Suppression following high dose chemo

III. Advantages: Compared with Bone Marrow Transplant

  1. More effective than Bone Marrow Transplant
  2. Much easier to harvest
    1. Identify CD34 Antigen via Monoclonal Antibody
  3. Small volume of peripheral stem cells effective
  4. Greater disease free survival than Bone Marrow
  5. Shorter hospitalization (2 weeks rather than 3 weeks)
  6. Much less costly

IV. Management: Surveillance of survivors treated with Hematopoietic Stem Cell Transplantation

  1. Complete Blood Count with differential
    1. Every 1-2 months for the first year THEN
    2. Every 3-6 months for the second year THEN
    3. Every 6 to 12 months
  2. Testing at one year following Stem Cell Transplantation
    1. Bone density (DEXA Scan)
    2. Ophthalmic exam
    3. Consult Hematology for testing testing at one year
      1. Previously one year labs have included CD4 Cell Count, Immunoglobulin level
      2. See annual lab testing below
  3. Annual lab testing
    1. Comprehensive metabolic panel
      1. Includes serum Electrolytes, Serum Glucose, Serum Creatinine, Blood Urea Nitrogen and Liver Function Tests
      2. Also obtain Serum Magnesium and Serum Phosphorus
    2. Urinalysis and Urine Microalbumin
    3. Serum Ferritin
    4. Other labs performed as needed
      1. Thyroid Stimulating Hormone
      2. Vitamin D
      3. Hemoglobin A1C
      4. Serum Testosterone in males
      5. Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) in females
  4. Routine Health Maintenance
    1. Annual physical exam
    2. Growth Assessment
    3. Dental exams at least annually
    4. Annual audiology exam
    5. Routine cancer screening including full body skin exam
    6. Immunizations
      1. Postpone Live Vaccines for at least 24 months after Hematopoietic Stem Cell Transplant
      2. Inactivated Vaccines may be given as early as 6 to 12 months after Hematopoietic Stem Cell Transplant
  5. Pulmonary Function Test indications
    1. If abnormal prior to treatment

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