Background: Increasing number of survivors following hematopoietic stem cell transplantation (HSCT) leads to necessity to focus also on careful monitoring for late effects. High dose chemotherapy and total body irradiation (TBI) is used for conditioning regimen in many patients. Thyreopathies belong to the most frequent among late endocrinopathies.
Objective: Aim of the study was to evaluate incidence of secondary thyroid malignancies after HSCT in young age, especially after TBI.
Population and methods: We analysed data (fT4, TSH, thyroid antibodies, thyroid function, and ultrasound imagine) of 288 (110F, 178M) surviving patients transplanted within the period 19892012 at median age 8.2 years (range 0.220.5) evaluated at age 17.9 years (1.840.5), after HSCT 8.5 years (1.324.3). Of them 177 subjects were treated for malignant diagnosis, TBI (1014 Gy) was used in 91 patients.
Results: Papillary thyroid carcinoma (PTC) micronodular, T1 or T2 stage was diagnosed in 4/288 patients (2F, 2M) 8.7 years (5.315.2) after HSCT. Of them three were previously treated for autoimmune thyroid disease (AITD) and ond for hypothyroidism. All but one had HSCT for malignant disease, in all TBI was used. Another nine patients (of them seven after TBI; n=4 treated for AITD) have been monitored for nodular goiter (FNAB confirmed benign thyroid nodule). In total 83/288 (29%) patients were treated for hypothyroidism or AITD.
Conclusions: Risk of secondary malignancies after HSCT is increasing within the time. Long-life late effects monitoring as an important part of post-transplant care is necessary. Regular sonographic evaluation of thyroid gland and neck is very important especially more than 5 years after HSCT and namely in all patients after TBI. Regular monitoring of thyroid function, laboratory parameters and ultrasound is highly recommended.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology