title: Lost in transition: the essential need for long-term follow-up clinic for blood and marrow transplantation survivors.
abstract: Because of expanding indications and improvements in supportive care, the utilization of blood and marrow cell transplantation (BMT) to treat various conditions is increasing exponentially, and currently more than 60,000 BMTs are performed annually worldwide. By the year 2030, it is projected that the number of BMT survivors will increase 5-fold, potentially resulting in one half of a million survivors in the United States alone. As the majority of survivors now live beyond the first 2 years after BMT, they are prone to a unique set of complications and late effects. Until recently, BMT experts assumed responsibility for almost all of the care for these survivors, but now oncologists/hematologists, pediatricians, and internists are involved frequently in offering specialized care and preventive services to these survivors. To integrate and translate into clinical practice the unique BMT survivorship issues with current preventive guidelines, a team effort is required. This can be facilitated by a dedicated "long-term-follow-up (LTFU)" clinic that provides lifelong care for BMT survivors. In this review, we first illustrate with clinical vignettes the need for LTFU and then focus upon the following: (1) types of LTFU clinic models, (2) challenges and possible solutions to the establishment of LTFU clinic, and (3) vulnerable transition periods.
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, Minnesota. Electronic address: shahrukh@mayo.edu.
authors.forename: Shahrukh
authors.initials: S
authors.lastname: Hashmi
authors.affiliation: Department of Hematology Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
authors.forename: Paul
authors.initials: P
authors.lastname: Carpenter
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.affiliation: Diagnostic Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Tichelli
authors.affiliation: Division of Hematology/Oncology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002386:Cataract / Q000191:economics / Q000209:etiology / Q000523:psychology / Q000628:therapy; D002648:Child; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000191:economics / Q000209:etiology / Q000523:psychology / Q000628:therapy; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D019337:Hematologic Neoplasms / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006782:Hospitals, Special / Q000191:economics*; D006801:Humans; D007037:Hypothyroidism / Q000191:economics / Q000209:etiology / Q000523:psychology / Q000628:therapy; D024821:Metabolic Syndrome / Q000191:economics / Q000209:etiology / Q000523:psychology / Q000628:therapy; D018803:Models, Economic; D013313:Stress Disorders, Post-Traumatic / Q000191:economics / Q000209:etiology / Q000523:psychology / Q000628:therapy; D017741:Survivors; D014481:United States; D000078329:Workforce
keywords: Blood and marrow transplantation; Late effects; Survivorship clinic