Distinctive characteristics of diabetes mellitus after hematopoietic cell transplantation during childhood

Abstract

We report on six patients who developed diabetes mellitus after hematopoietic cell transplantation (HCT). The prevalence in our cohort of long-term survivors after HCT performed below 18 yr of age was 3%. The median age at onset of diabetes was 22.4 yr (range 11.3-34.4). The median period between HCT and diabetes was 10.1 yr (range 5.6-22.1). Five out of the six patients received total irradiation therapy and five had other endocrinological abnormalities. The onset of diabetes in all patients was insidious and none had diabetic ketoacidosis. Body mass indexes at diabetes onset were within normal levels. The clinical and laboratory features that characterized our patients with diabetes after HCT make it difficult to classify them as having type-1 or type-2 diabetes. The relatively high prevalence of diabetes and its insidious onset in this group of patients, advocate clinicians to evaluate carefully even slight variations in fasting blood glucose, usually included in the routine biochemistry follow-up. These data also suggest that HbA1c and oral glucose-tolerance test should be added to the follow-up program of late complications if fasting blood glucose levels are slightly increased.

Endocrinological late complications after hematopoietic SCT in children

“…An extremely limited number of studies have reported data on abnormalities of glucose metabolism in long-term survivors after HSCT during childhood. [32][33][34][35] Many issues of diabetes mellitus in HSCT patients still remain unclear.…”

“…In a recent paper, Bonanomi et al 35 reported 6 patients in a cohort of 201 patients transplanted before age 18 years who developed diabetes mellitus at a median age of 10.1 years (range 5.6-22.1). The unique clinical and laboratory features that characterized these patients with diabetes mellitus after HSCT suggested that this should be considered as a unique and specific entity within the commonly used classifications for diabetes mellitus.…”

Diabetes Mellitus after Allogeneic Hematopoietic Stem Cell Transplantation

“…Unique clinical and laboratory features that characterized patients with DM after HSCT suggested that this should be considered as a specific entity within the commonly used classifications for DM [7,8]. For the same reason, the treatment of DM after HSCT remains overt to discussion.…”

“…According to different reports, the occurrence of those abnormalities is quite common and reaches between 20 and 50% [1,2,3]. The occurrence of diabetes mellitus (DM) after HSCT is a relatively recent observation [4,5,6,7,8,9]. Survivors of allogeneic HSCT were 3.65 times more likely to develop diabetes than siblings and 3 times more likely than the general US population [10,11].…”

“…The etiopathogenesis of DM after transplantation is unclear and most possibly multifactorial, involving side effects of chemotherapeutic agents, pancreatic irradiation, cytokine influence, endocrine replacement, corticosteroid therapy and genetic predisposition [5,7,8,12,13,14]. …”