Time‐course and risk factors of hypothyroidism following allogeneic hematopoietic stem cell transplantation (HSCT) in children conditioned with fractionated total body irradiation

Bailey, Heidi K.; Kappy, Michael S.; Giller, Roger; Gralla, Jane

doi:10.1002/pbc.21634

Cited by 24 publications

(14 citation statements)

References 24 publications

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“…However, at the proximal femur, 75–80% of adult peak BMD is achieved by age 12–13 years 11 and all patients who had FNBMD measured, including controls, were ≥20 years. Higher prevalence of hypothyroidism in the group <10 years at HCT is consistent with other studies that found a strong association between young age at HCT and thyroid dysfunction, likely due to higher sensitivity of the thyroid gland to radiation in younger patients 36, 37 . It is difficult to determine if hypothyroidism and lower BMD Z-score are causally related in this cohort because all patients (except one) were euthyroid at the study visit.…”

Section: Discussionsupporting

confidence: 91%

Bone mineral deficits in recipients of hematopoietic cell transplantation: the impact of young age at transplant

Petryk

Polgreen

Zhang

et al. 2013

Bone Marrow Transplant

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Low bone mineral density (BMD) has been reported in recipients of pediatric hematopoietic cell transplantation (HCT), but it is unclear whether age at HCT plays a role. The objective of this cross-sectional study was to determine if patients treated with HCT before age 10 years have long-term BMD deficits compared to patients transplanted at an older age and to sibling controls. The study included 151 HCT recipients (87 males), age at study 24.7±8.6 years treated with HCT for hematologic malignancies at age 10.9±6.4 years, and 92 healthy sibling controls (49 males), age at study 22.3±8.0 years. Dual-energy x-ray absorptiometry was performed to measure BMD Z-scores for total body (TBMD), lumbar spine (LBMD), and femoral neck (FNBMD, for subjects ≥20 years at study visit). Patients <10 years at HCT had significantly lower TBMD and FNBMD Z-scores (by 0.5 and 0.8 SD, respectively) compared to controls (P=0.003 and P=0.0001, respectively) and patients >18 years at HCT (P=0.04 and P=0.004, respectively) at an average of 14 years after HCT. In conclusion, this study identified young age at transplant as an important risk factor for bone deficits in young adulthood, suggesting that efforts to reduce bone loss should focus on this patient population.

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Section: Discussionsupporting

confidence: 91%

Bone mineral deficits in recipients of hematopoietic cell transplantation: the impact of young age at transplant

Petryk

Polgreen

Zhang

et al. 2013

Bone Marrow Transplant

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“…Risk is further increased by prior radiation exposure to the thyroid (especially cumulative doses ≥20 Gy), and increased time since exposure. 14;21;22 In general, females are at higher risk of thyroid disease compared with males, and younger age at exposure has been implicated as an additional risk factor in some studies. 23;24 Notably, for thyroid cancer, risk may begin to decrease at radiation doses beyond 30 Gy compared with lower doses due to ablation and fibrosis of thyroid tissue.…”

Section: Endocrinementioning

confidence: 99%

Late Effects Surveillance Recommendations among Survivors of Childhood Hematopoietic Cell Transplantation: A Children's Oncology Group Report

Chow

Anderson

Baker

et al. 2016

Biology of Blood and Marrow Transplantation

180

152

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Hematopoietic cell transplantation (HCT) is an important curative treatment for children with high-risk hematologic malignancies and solid tumors, and increasingly, non-malignant diseases. Given improvements in care, there is a growing number of long-term survivors of pediatric HCT. Compared with non-transplanted childhood cancer survivors, HCT survivors have been shown to have a substantially increased burden of serious chronic conditions and impairments involving virtually every organ system and overall quality of life. This likely reflects the joint contributions of pre-transplant treatment exposures and organ dysfunction, the transplant conditioning regimen, and any post-transplant graft versus host disease (GVHD). In response, the Children’s Oncology Group (COG) has created Long-Term Follow-Up Guidelines (www.survivorshipguidelines.org) for survivors of childhood, adolescent, and young adult cancer, including those treated with HCT. Guidelines taskforces, consisting of HCT specialists, other pediatric oncologists, radiation oncologists, organ-specific subspecialists, nurses, social workers, other healthcare professionals, and patient advocates have systematically reviewed the literature with regards to late effects after childhood cancer and HCT since 2002, with the most recent review completed in 2013. For the most recent review cycle, over 800 articles from the medical literature relevant to childhood cancer and HCT survivorship were reviewed, including 586 original research articles. Provided here-in is an organ system-based overview that emphasizes the most relevant COG recommendations (with accompanying evidence grade) for the long-term follow-up care of childhood HCT survivors (regardless of current age) based on a rigorous review of the available evidence. These recommendations cover both autologous and allogeneic HCT survivors, those transplanted for non-malignant diseases, and those with a history of chronic GVHD.

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“…Hypothyroidism haven been reported to be as high as 52% of patients with allogeneic hematopoietic stem cell transplantation (Al-Hazzouri et al 2009;Bailey et al 2008;Berger et al 2005;Sanders et al 2009). The time course of developing hypothyroidism after hematopoietic stem cell transplantation varied based on the conditioning regimen.…”

Section: Allogeneic Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%

“…From an immunological standpoint, stem cells from matched sibling donors are though to be less immunologically reactive than those from unrelated donors. Patients who received stem cells from an unrelated donor had over an eightfold increased risk of hypothyroidism compared to those who received matched sibling stem cells (Bailey et al 2008). Total body irradiation is a well established risk factor for hypothyroidism after hematopoietic stem cell transplantation and used of fractionated instead of single-dose total body irradiation decreases its risk (Boulad et al 1995).…”

Section: Allogeneic Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%

Treatment Related Hypothyroidism, a Viewpoint from Cancer Therapy and Hematopoietic Stem Cell Transplantation

Tsao¹,

Feng²

2012

Hypothyroidism - Influences and Treatments

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Time‐course and risk factors of hypothyroidism following allogeneic hematopoietic stem cell transplantation (HSCT) in children conditioned with fractionated total body irradiation

Cited by 24 publications

References 24 publications

Bone mineral deficits in recipients of hematopoietic cell transplantation: the impact of young age at transplant

Bone mineral deficits in recipients of hematopoietic cell transplantation: the impact of young age at transplant

Late Effects Surveillance Recommendations among Survivors of Childhood Hematopoietic Cell Transplantation: A Children's Oncology Group Report

Treatment Related Hypothyroidism, a Viewpoint from Cancer Therapy and Hematopoietic Stem Cell Transplantation

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