From the Research
The recommended monitoring algorithm for patients with hemoglobinopathies after hematopoietic cell transplantation (HCT) involves regular assessment of donor chimerism, hemoglobin levels, and hemoglobin electrophoresis, as outlined in the most recent study 1.
Monitoring Schedule
- Patients should undergo chimerism testing at 1,3,6, and 12 months post-transplant, then annually thereafter to evaluate engraftment stability.
- Complete blood counts should be performed weekly for the first 3 months, then monthly until 6 months, quarterly until 1 year, and annually thereafter.
- Hemoglobin electrophoresis should be conducted at 3,6, and 12 months post-transplant to assess the production of normal hemoglobin.
Transplant-Related Complications
- Patients require monitoring for transplant-related complications including graft-versus-host disease, infections, and organ toxicity, as highlighted in 2 and 3.
Iron Overload Assessment
- Iron overload assessment via serum ferritin and liver MRI should be performed at 1 year post-transplant, with phlebotomy or chelation therapy initiated if ferritin exceeds 1000 ng/mL, as suggested in 4 and 5.
Rationale
This comprehensive monitoring approach is essential because stable mixed chimerism (>20% donor cells) is often sufficient to correct the hemoglobinopathy phenotype, and early detection of decreasing donor chimerism allows for timely intervention to prevent graft failure and disease recurrence, as discussed in 1.