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Long-term thyroid disorders in pediatric survivors of hematopoietic stem cell transplantation after chemotherapy-only conditioning

  • Luminita N. Cima ORCID logo EMAIL logo , Sorina C. Martin , Ioana M. Lambrescu , Lavinia Stejereanu , Cristina Zaharia , Anca Colita and Simona Fica
Published/Copyright: June 23, 2018
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 31 Issue 8

Abstract

Background:

Thyroid dysfunction (TD) was usually described in hematopoietic stem cell transplantation (HSCT) recipients who were given total body irradiation (TBI) in the conditioning regimen. Because previous studies have reported discrepant results regarding the presence of long-term thyroid complications in HSCT survivors following chemotherapy-only conditioning, we investigated the frequency of thyroid abnormalities in a series of children treated with HSCT for different disorders without TBI as part of the conditioning protocol.

Methods:

We compared thyroid-stimulating hormone, free thyroxine, total triiodothyronine (TT3), anti-peroxidase (TPO Ab) and anti-thyroglobulin antibodies and thyroid volume z-score in 28 HSCT survivors and 16 healthy subjects matched for age and sex.

Results:

HSCT recipients had a higher frequency of TD and thyroid complications in total, including TD and euthyroid Hashimoto thyroiditis, compared to the control group. Patients transplanted for Hodgkin lymphoma (HL) were more likely to develop a thyroid complication compared to patients with non-malignant hematologic diseases and leukemia patients. BEAM (carmustine, etoposide, citarabin and melphalan) conditioning compared to busulfan (Bu) and fludarabine (Flu)-based regimens and autologous compared to allogenic grafting were associated with a higher prevalence of TD in our study. HSCT survivors had higher mean serum TT3 levels. A multivariate analysis revealed that autologous (auto)-HSCT recipients had higher mean serum titers of TPO Ab compared to allogenic (allo)-HSCT recipients and controls and the mean thyroid volume z-score was significantly higher in controls compared to auto-/allo-HSCT survivors.

Conclusions:

We identified a 35.7% prevalence of thyroid abnormalities, emphasizing the need for a long-term surveillance of thyroid function and morphology even in this group of patients who were not exposed to TBI.

Keywords: chemotherapy-only conditioning; hematopoietic stem cell transplantation; pediatric recipients; thyroid disorders

  1. Author contributions: C.L. performed the literature review for documentation, designed the article, collected and assembled data from patients’ sheets, interpreted results and drafted the paper. L.I., S.L. and Z.C. contributed with patient care and reviewed the paper. S.M. helped with the data analysis in SPSS and critically reviewed the paper. C.A. and F.S. contributed with patient care and critically reviewed the paper. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplementary Material:

The online version of this article offers supplementary material (https://doi.org/10.1515/jpem-2018-0020).

Received: 2018-01-14
Accepted: 2018-05-14
Published Online: 2018-06-23
Published in Print: 2018-08-28

©2018 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Urinary bisphenol-A levels in children with type 1 diabetes mellitus
  4. The relationship between metabolic syndrome, cytokines and physical activity in obese youth with and without Prader-Willi syndrome
  5. Association of anthropometric measures and cardio-metabolic risk factors in normal-weight children and adolescents: the CASPIAN-V study
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  7. Hereditary 1,25-dihydroxyvitamin D-resistant rickets (HVDRR): clinical heterogeneity and long-term efficacious management of eight patients from four unrelated Arab families with a loss of function VDR mutation
  8. Long-term thyroid disorders in pediatric survivors of hematopoietic stem cell transplantation after chemotherapy-only conditioning
  9. Screening for autoimmune thyroiditis and celiac disease in minority children with type 1 diabetes
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  13. Molecular genetics of tetrahydrobiopterin deficiency in Chinese patients
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  15. Next-generation sequencing as a second-tier diagnostic test for newborn screening
  16. Case Reports
  17. Thyroid storm after choking
  18. Three new Brazilian cases of 17α-hydroxylase deficiency: clinical, molecular, hormonal, and treatment features
  19. Diazoxide toxicity in a child with persistent hyperinsulinemic hypoglycemia of infancy: mixed hyperglycemic hyperosmolar coma and ketoacidosis
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https://doi.org/10.1515/jpem-2018-0020
Keywords for this article
chemotherapy-only conditioning; hematopoietic stem cell transplantation; pediatric recipients; thyroid disorders

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Urinary bisphenol-A levels in children with type 1 diabetes mellitus
  4. The relationship between metabolic syndrome, cytokines and physical activity in obese youth with and without Prader-Willi syndrome
  5. Association of anthropometric measures and cardio-metabolic risk factors in normal-weight children and adolescents: the CASPIAN-V study
  6. The effect of obesity and insulin resistance on macular choroidal thickness in a pediatric population as assessed by enhanced depth imaging optical coherence tomography
  7. Hereditary 1,25-dihydroxyvitamin D-resistant rickets (HVDRR): clinical heterogeneity and long-term efficacious management of eight patients from four unrelated Arab families with a loss of function VDR mutation
  8. Long-term thyroid disorders in pediatric survivors of hematopoietic stem cell transplantation after chemotherapy-only conditioning
  9. Screening for autoimmune thyroiditis and celiac disease in minority children with type 1 diabetes
  10. Resistance exercise alone improves muscle strength in growth hormone deficient males in the transition phase
  11. Sequential measurements of IGF-I serum concentrations in adolescents with Laron syndrome treated with recombinant human IGF-I (rhIGF-I)
  12. Symptomatic Rathke cleft cyst in paediatric patients – clinical presentations, surgical treatment and postoperative outcomes – an analysis of 38 cases
  13. Molecular genetics of tetrahydrobiopterin deficiency in Chinese patients
  14. Single center experience of biotinidase deficiency: 259 patients and six novel mutations
  15. Next-generation sequencing as a second-tier diagnostic test for newborn screening
  16. Case Reports
  17. Thyroid storm after choking
  18. Three new Brazilian cases of 17α-hydroxylase deficiency: clinical, molecular, hormonal, and treatment features
  19. Diazoxide toxicity in a child with persistent hyperinsulinemic hypoglycemia of infancy: mixed hyperglycemic hyperosmolar coma and ketoacidosis
  20. Refractory hypoglycemia in a pediatric patient with desmoplastic small round cell tumor
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