Endocrinological complications of long term survivors after hematopoietic stem cells transplantation

Hematopoietic stem cells transplantation (HSCT) is accepted therapeutic option for malignancies, hematological and congenital diseases. Advances in conditioning regimens, GVHD treatment and supportive care have increased numbers of long term survivors. Long term complications have occured as a problem by increased numbers of survivors. A wide variety of non malignant long term complications of HSCT reduce the quality of life and rarely cause mortality except immunological complications like GVHD. The most common complication of long term follow-up after HSCT is endocrinological complications. In this study, patients followed by Gazi University Faculty of Medicine Stem Cells Transplantation Clinic evaluated for long term endocrinological complications and potential risk factors of these complications. Within the context of study, we examined 169 patients who underwent HSCT between 2003-2012 and survived at least 1 year after HSCT without relapsing. The median follow up period in allogeneic and autogeneic HSCT recipients were 38 and 31 months. Obesity (%4,5 vs %11,8), dyslipidemia (%77,3 vs %50), DM (%11,1 vs %7,8), HT (%36,5 vs %21,1), metabolic syndrome (%6,8 vs 10,8), hypothyroidism (%21,7 vs %16,7), osteoporosis/osteopenia (%58,2 vs %42,2), avascular bone necrosis (%13,9 vs 0) and hypogonadism (%27,8 vs %16,1) developed in allogeneic and autogeneic SCT recipients. However, hyperthyroidism (%18,9 vs %10,6) and euthyroid sick syndrome (%10 vs %3) developed in the first few months and temporary. Administration of CsA was found a risk factor for development of dyslipidemia but Tacrolimus and MMF were not. Risk factors of development of HT were male gender, age, metabolic syndrome, obesity, CsA and steroid treatments. Also age and CsA were found risk factors for development of osteopenia/osteoporosis. However steroid was not found risk factor for development of osteopenia/osteoporosis, explanied by using Ca and vitamine D. Steroids treatment was a indipendent risk factor for avascular bone necrosis. Risk factors for development of hypogonadism were female gender, conditioning with busulfan, acute GVHD and CsA. Short term use of CsA was risk factor for development of dyslipidemia, hypothyroidism, osteopenia/osteoporosis and hypogonadism. These results maybe explained by ?occult or undifened? immun reaction. The complications were suppresed with post-transplant long term use of CsA and were more frequently seen in patients early discontinuation of CsA who have no classical GVHD signs. However, further studies are needed to prove this hypothesis.