Backgroud: Allogeneic haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for a variety of malignant and non-malignant disorders. With improved outcomes, increasing attention has been drawn to late complications in long-term survivors. Secondary cancer belongs to the most serious complications.
Objective: Occurrence of secondary solid tumours at HSCT Unit, University Hospital Prague- Motol was analysed.
Methods: We evaluated data on clinical and laboratory follow-up (including fT4, TSH, thyroid antibodies, thyroid function and ultrasound imaging) in 499 patients (315 M, 184 F) who underwent allogeneic HSCT during childhood between 1989 to 2014.
Results: Secondary solid tumours were diagnosed in 16 patients (3.2%) at median time 11.4 (range 5.417.8) years after HSCT (thyroid carcinoma n=8, carcinoma of oral cavity n=3, malignant schwannoma n=2, melanoma n=1, peritoneal mesothelioma n=1, breast cancer n=1). 15 out of 16 patients (93.8%) had total body irradiation (TBI) 1214.4 Gy as a part of conditioning regimen. All patients underwent surgery and/or chemo-radiotherapy and are alive. Papillary carcinoma (in all cases micronodular, T1 or T2 stage) was found in all 8 patients (5F, 3M) (50% of all with secondary solid tumour) at median time 10.8 years (range 5.417.0) after HSCT. Three of them were previously treated with thyroxine for autoimmune thyroid disease, one for hypothyroidism and another one for nodular goitre. All but one had HSCT for malignant disease, and 7/8 had TBI.
Conclusions: The incidence and number of complications following allogeneic HSCT in childhood are increasing within time and thyroid cancer was the most frequent secondary solid tumour detected. The early diagnosis is one of the key tasks of longlife multidisciplinary post-transplant care including regular ultrasound evaluation of thyroid gland and neck especially more than 5 years after HSCT and namely after TBI. Supported by MHCZ for conceptual development 00064203 University Hospital Motol.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology