1. Pre, and 3, 6, 12 months post bone marrow transplantation then yearly | - Triglycerides (TG) |
- Cholesterol: HDL/LDL | |
- Fasting blood glucose, HbA1c | |
2. Prior to treatment, rule out hypothyroidism, nephrotic syndrome and cholestasis, by checking | - TSH, free T4 |
- 24-hour proteinuria, | |
- bilirubin and alkaline phosphatases | |
3. Then treat according to the cardiovascular risk (factors listed in Table 9 ), | - If high cardiovascular risk, dyslipidaemia must be treated. |
- If low cardiovascular risk, treat according to | |
- severity of dyslipidemia | |
- prognosis of the transplantation. | |
- liver enzyme profile. | |
4. Adjust treatment according to LDL cholesterol and triglycerides levels | - Dietary and lifestyle measures always advisable. |
- Modify the dose of immunosuppressantif possible as the 1st step | |
- If LDL cholesterol high and triglycerides <2 g/L: statin at the lowest dose to limit toxicity. NB pravastatin and fluvastatin, metabolized through alternative pathways = best choice in patients requiring co-administration of cytochrome P3A4 inhibitors | |
5. If mixed hyperlipidaemia or resistance to statin, add | - ezetimibe to statins, rather than increase the statin dose. |
- fibrates but increases the risk of muscle disorders | |
6. If isolated hypertriglyceridemia >8 g/L | - fibrates alone to limit the risk of acute pancreatitis. |
7. Follow-up | - Liver biology after 15 days and monthly after. |
- If transaminases levels is >5 N and/or muscular pain, treatment must be stopped and CPK evaluation is required. | |
- Inform the patient of potential side effects so that he/she can alert his/her primary care physician |