Endocrine sequelae of adult recipients of hematopoietic stem cell transplantation

Georgia Ntali; Efstratios Kardalas; Aikaterini Beka; Evrydiki Theodorou; Maria Zotou; Anastasia Lambraki; Elisavet Tiaka; Vasiliki Antonopoulou; Frini Karaolidou; Zoi Arapidou; Barvara Vlassopoulou; Dimitrios Karakasis; Tatiana Tzenou; Ifigenia Tzannou; Ioannis Tsonis; Marinella Tzanela; Stavros Gigantes; Ioannis Baltadakis

doi:10.1530/endoabs.99.EP247

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Endocrine Abstracts (2024) 99 EP247 | DOI: 10.1530/endoabs.99.EP247

ECE2024 Eposter Presentations Endocrine-Related Cancer (90 abstracts)

Endocrine sequelae of adult recipients of hematopoietic stem cell transplantation

Georgia Ntali ¹ , Efstratios Kardalas ¹ , Aikaterini Beka ¹ , Evrydiki Theodorou ² , Maria Zotou ¹ , Anastasia Lambraki ¹ , Elisavet Tiaka ¹ , Vasiliki Antonopoulou ¹ , Frini Karaolidou ² , Zoi Arapidou ² , Barvara Vlassopoulou ¹ , Dimitrios Karakasis ² , Tatiana Tzenou ² , Ifigenia Tzannou ² , Ioannis Tsonis ² , Marinella Tzanela ¹ , Stavros Gigantes ² & Ioannis Baltadakis ²

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¹Evangelismos General Hospital, Department of Endocrinology "Dionysios Ikkos”-Diabetes Center, Athens, Greece; ²Evangelismos General Hospital, Department of Hematology and Bone Marrow Transplantation Unit, Athens, Greece

Introduction: Hematopoietic stem cell transplantation (HSCT) is the standard of care treatment for high-risk hematological malignancies. HSCT recipients are exposed to chemotherapy and/or radiation prior to HSCT, as part of the conditioning, or following HSCT for management of disease relapse. They may receive steroids for chronic graft-versus-host disease (cGvHD) and they are at high risk for endocrine complications.

Aim: To evaluate endocrine complications in HSCT survivors.

Patients/Methods: Retrospective analysis of HSCT recipients, who were referred to the Outpatient Endocrine Clinic of Evangelismos Hospital (Athens).

Results: 109 patients (45 males) were enrolled. Their median age at diagnosis of hematological malignancy and HSCT was 31 (range 13-64) and 33 years (13-65) respectively. Patients had received a single allogeneic (n=81) or autologous (n=9) HSCT, or a 2nd allotransplant (n=1). Data for transplant type missed for 18 patients. Median follow-up duration from HSCT was 71 months (3-300). Data for thyroid function before HSCT were available for 86 patients. 81/86 (94%) were euthyroid, 5/86 (6%) were hypothyroid. At last assessment, thyroid data were available for 83. 58/83 (70%) were euthyroid, 25/83 (30%) were hypothyroid. Amongst hypothyroid patients 4 (16%) had been treated with total body irradiation (TBI), including 3 (12%) with a dose of ≥12Gy. At last assessment, data for metabolic syndrome (MS) were available for 106. Fifty-two (48.5%) fulfilled (MS) criteria. Of those, 9 (17%) had received TBI and 30 (61%) glucocorticoids. At last assessment, data for osteoporosis were available for 45 patients. Osteoporosis was noted in 12 (26.6%), and 8/12 (66.6%) had received glucocorticoids. Eleven had developed avascular necrosis, all following steroids. Data for cGvHD were available for 80 patients. Fifty-seven (71%) had a cGvHD diagnosis and 51 (89.4%) had received glucocorticoids. Age at transplant was a predictor of the development of metabolic syndrome, hypothyroidism and osteoporosis, with older patients being more vulnerable. Odds Ratio (OR) for (MS) was 2.51 (95%CI:1.07-5.93, P=0.02) for patients aged ≥35 vs <35 years. OR for hypothyroidism was 2.89 (95%CI: 0.8-10.04, P=0.056) for patients aged ≥50 vs <50 years. OR for osteoporosis was 4.38 (95%CI: 0.87-22.35, P=0.03) for patients aged ≥40 vs <40 years. TBI and glucocorticoids did not emerge as significant predictive factors.

Conclusions: The population of HSCT survivors steadily increases over time. Endocrine complications may ensue during follow-up, with older age at transplantation as a significant predisposing factor. The long latency interval from HSCT necessitates their life-long monitoring for endocrine sequelae.