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Table 9 Screening of metabolic complications and management of dyslipidemia (see Tables 5 and 6 for diabetes management)

From: Management of endocrino-metabolic dysfunctions after allogeneic hematopoietic stem cell transplantation

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