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Thyroid dysfunction in adult patients late after autologous and allogeneic blood and marrow transplantation

Bone Marrow Transplantation volume 47, pages 296–298 (2012)Cite this article

Thyroid function testing is recommended by international guidelines for all blood and marrow transplant (BMT) survivors yearly after the procedure or if new relevant symptoms develop.1 The occurrence of thyroid dysfunction (TDF) as a complication of BMT and the factors associated with it have been described primarily in pediatric recipients of allogeneic BMT.2, 3, 4 However, fewer studies have analyzed the incidence of this complication in adults,5, 6, 7 in particular after autologous BMT.5 In this study, we retrospectively analyzed the incidence of TDF in all consecutive adult BMT recipient survivors from our center for whom serial monitoring of thyroid-stimulating hormone (TSH) and free T4 (FT4) levels were available (n=169 adults; Table 1). This population is representative of the overall BMT population for the same period (February 1993–April 2008) in terms of patient and transplant characteristics, such as type of BMT (autologous vs allogeneic), type of allogeneic donor (related vs unrelated), type of conditioning for allogeneic BMT (myeloablative vs non-myeloablative), gender, age at BMT, underlying disease and source of progenitors (data not shown).

Table 1 Patient and transplant characteristics and their association with thyroid dysfunction
Full size table

Out of 169 patients included in the study, 62 (37%) developed TDF after BMT, including 54 cases of subclinical hypothyroidism (increased TSH, normal FT4 and no clinical symptoms; 32%), 6 cases of overt primary hypothyroidism (increased TSH and reduced FT4; 4%) and 2 additional cases of subclinical hyperthyroidism (reduced TSH and normal FT4; 1%). All cases of primary hypothyroidism started oral L-thyroxine replacement therapy. Their dose of L-thyroxine is adjusted when required, based on hormone level assessments performed at 6-monthly intervals. Cases of subclinical TDF are monitored periodically, including cases of subclinical hyperthyroidism, which maintain detectable TSH levels (0.1–0.4 mU/L), are younger than 60 years of age, have normal bone mineral density, no underlying heart disease or symptoms of hyperthyroidism, are in keeping with endocrinology review, and have not required treatment to date. The onset of TDF took place overall at a median of 39 months after BMT (mean 55; range 8–169), with more than 25% of cases first developing it between 7 and 14 years after BMT (third quartile 94 months). In particular, TDF after autologous BMT had a significantly longer time to onset (median 47 months, mean 63, range 9–169) than after allogeneic BMT (median 18 months, mean 23, range 8–58; P=0.010). One-quarter of the TDF cases after autologous BMT in our series presented nearly 9 years or longer after the procedure, a finding that reinforces the relevance of long-term monitoring to assess the real impact of TDF in this population. Indeed, the effect of the type of BMT on the risk of TDF as a time-dependent variable was non-proportional over time, as there were no differences in cumulative incidence of TDF in the first 5 years (autologous 29.9% vs allogeneic 30.3%), but from year 5 onwards our data showed a statistical trend toward a higher cumulative incidence of TDF after autologous than after allogeneic BMT (relative risk: 3.5, 95% confidence interval 0.92–8.3, P=0.06). In keeping with this finding, the overall prevalence of TDF was higher after autologous than after allogeneic BMT (43 vs 24%, respectively; P=0.020, chi-square), despite both groups having comparable median lengths of follow-up (autologous 69 months vs allogeneic 63 months; P=0.202). Cumulative incidence was calculated using NCSS 97 (Kaysville, UT, USA) and all other computations using SPSS 15.0 (Chicago, IL, USA).

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Authors and Affiliations

  1. Department of Haematology, Catalan Institute of Oncology (ICO), Hospital Duran i Reynals, Barcelona, Spain

    I Sánchez-Ortega, T Peralta, R Parody, V Clapés, A F de Sevilla & R F Duarte

  2. Blood and Tissues Bank, Hospital Vall d’Hebron, Barcelona, Spain

    C Canals

  3. Universitat Autonoma de Barcelona, Barcelona, Spain

    I Sánchez-Ortega

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  1. I Sánchez-Ortega
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Correspondence to R F Duarte.

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Sánchez-Ortega, I., Canals, C., Peralta, T. et al. Thyroid dysfunction in adult patients late after autologous and allogeneic blood and marrow transplantation. Bone Marrow Transplant 47, 296–298 (2012). https://doi.org/10.1038/bmt.2011.54

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