Managing Endocrine Disorders in Adults After Hematopoietic Stem Cell Transplantation

Abstract

Hematopoietic stem cell transplantation (HSCT) has become a potentially curative therapy for an increasing number of malignant and non-malignant conditions. As survival rates continue to improve, the focus of patient care has shifted from managing not only immediate but also long-term complications. Endocrine disorders are among the most prevalent late effects following HSCT. Detecting and treating such conditions offer new challenges, as well as opportunities to reduce preventable morbidity and mortality associated with HSCT. Our objective is to summarize recent literature and describe practical approaches to screening for and managing endocrine-related late effects. We focus on dyslipidemia, diabetes, thyroid disorders, osteoporosis, and hypogonadism. Mechanisms, monitoring, and management recommendations for each disorder are outlined. Growing data on these disorders in the post-transplant setting highlight the need for future study and evidence-based guidelines.

Long‐term Follow‐up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics

“…130,131 Thyroid Disorders Thyroid disorders have been observed post-HCT and untreated thyroid disorders can lead to cardiac and metabolic complications. 132 Monitoring of free thyroxine (T4) and thyroid stimulating hormone (TSH) should occur annually after HCT or as clinically indicated. 2,132 Hypothyroidism has a long-term prevalence of 20-50% in HCT survivors and has been linked to TBI, immune suppression, and autoimmune antibodies.…”

“…132 Monitoring of free thyroxine (T4) and thyroid stimulating hormone (TSH) should occur annually after HCT or as clinically indicated. 2,132 Hypothyroidism has a long-term prevalence of 20-50% in HCT survivors and has been linked to TBI, immune suppression, and autoimmune antibodies. 132,133 Hypothyroidism may be treated with levothyroxine in cases of overt primary or central hypothyroidism and dosed based on age, ideal body weight, and presence of cardiac comorbidities; lower doses may also be used during initiation (Table 5).…”

“…2,132 Hypothyroidism has a long-term prevalence of 20-50% in HCT survivors and has been linked to TBI, immune suppression, and autoimmune antibodies. 132,133 Hypothyroidism may be treated with levothyroxine in cases of overt primary or central hypothyroidism and dosed based on age, ideal body weight, and presence of cardiac comorbidities; lower doses may also be used during initiation (Table 5). Hyperthyroidism is less common, but can also occur as a result of donor-recipient transfer of B and T lymphocytes and patients with hyperthyroidism should be referred to an endocrinologist.…”

“…Hyperthyroidism is less common, but can also occur as a result of donor-recipient transfer of B and T lymphocytes and patients with hyperthyroidism should be referred to an endocrinologist. 132,133 Metabolic Syndrome Metabolic syndrome encompasses interrelated factors that can increase the risk of cardiovascular disease (CVD). Diagnostic criteria for metabolic syndrome consist of abdominal obesity, dyslipidemia, elevated blood pressure, and hyperglycemia.…”

“…132 Patients with allogeneic HCT have a 7-fold increase in the risk of having a cardiovascular (CV) event, and the median age at which they have their first CV event is far lower than the general population at 53 years of age versus 67 years, respectively. 132 The incidence of dyslipidemia has been reported to increase after HCT, from 28% pre-HCT to 74% at 3 months after HCT to 89% at 25 years after allogeneic HCT. 132 In addition, more HCT survivors require lipid lowering medication compared with the general population.…”