Prolonged Chronic Graft-versus-Host Disease is a Risk Factor for Thyroid Failure in Long-Term Survivors After Matched Sibling Donor Stem Cell Transplantation for Hematologic Malignancies

Abstract

We studied thyroid function in 81 long term survivors of allo-SCT (median follow-up 84 months, range 45–166). Median age at transplant was 35 years (range 6–66). Seventy two received a total body irradiation conditioning regimen (12Gy 23; 13Gy 49). Twenty one (25.9%) had subclinical hypothyroidism and 9 (11.1%) developed overt hypothyroidism at a median of 28 months (range 3–78) after allo-SCT. Multivariate logistic regression analysis showed prolonged immunosuppressive therapy (IST) was significantly associated with subclinical (OR 3.8) and overt (OR 2.6) hypothyroidism. Anti-Thyroglobulin and Thyroid Peroxidase Antibody were detected in 12 of 60 (20%) patients tested. There was no correlation between the occurrence of thyroid antibodies and hypothyroidism (p=0.13) or cGVHD (p=0.55). In conclusion, thyroid dysfunction is relatively common after SCT and is more likely to occur in patients receiving prolonged IST for cGVHD. However, thyroid dysfunction did not appear to be related to an antibody-mediated autoimmune process.

Thyroid dysfunction in adult patients late after autologous and allogeneic blood and marrow transplantation

“…1 The occurrence of thyroid dysfunction (TDF) as a complication of BMT and the factors associated with it have been described primarily in pediatric recipients of allogeneic BMT. [2][3][4] However, fewer studies have analyzed the incidence of this complication in adults, [5][6][7] in particular after autologous BMT. 5 In this study, we retrospectively analyzed the incidence of TDF in all consecutive adult BMT recipient survivors from our center for whom serial monitoring of thyroid-stimulating hormone (TSH) and free T4 (FT4) levels were available (n ¼ 169 adults; Table 1).…”

“…[5][6][7] These studies focused on allogeneic BMT, and only one of them, by Somali et al, 5 included cases of autologous BMT, showing no difference in their incidence of TDF compared with their allogeneic BMT counterparts. This negative finding in Somali's study is not surprising if we take into consideration both the lower number of cases included in the study (29 autologous and 43 allogeneic) and their shorter follow-up time of only 1.5 years, considering our findings on the late onset of TDF after autologous BMT.…”

Conséquences endocriniennes, osseuses et métaboliques des greffes de cellules souches hématopoïétiques allogéniques chez l’adulte

“…Si les études sont unanimement en faveur d'un traitement substitutif chez l'enfant avec de bons résultats sur la croissance, 67 son usage chez l'adulte semble moins indispensable dans la mesure où il existerait une augmentation du risque de tumeur solide secondaire chez les enfants traités. 68 Des études chez l'adulte doivent être réalisées pour rassurer le prescripteur et permettre une substitution chez ces patients afin d'éviter les conséquences de l'insuffisance somatotrope : ostéoporose, augmentation de la masse graisse, fatigabilité à l'effort, majoration du risque cardiovasculaire et altération de la qualité de vie. 62,69 E.…”

Hypothyroidism following allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia

“…Mostly, thyroid dysfunction is due to low T3 syndrome reflecting the general health of the patients; however, the development of chronic thyroiditis, hyper-, and hypothyroidism is frequent [14,15]. Hypothyroidism is one of the most common endocrinopathies occurring after HSCT with a prevalence of 13-25% for subclinical hypothyroidism and 4-11% for overt hypothyroidism [16][17][18]. Several risk factors, including cGvHD, prolonged immunosuppressive therapy, HLA B35 of the donor, and female donors to male recipients has been described in different patient cohorts [14,16,17], but large long-term studies about hypothyroidism after allo-HSCT for AML are still lacking.…”