Abstract
Purpose
To evaluate the effects of total body irradiation (TBI) on the endocrine system in adults treated with hematopoietic cell transplantation (HCT) during childhood.
Methods
We studied 40 patients who underwent HCT between 1988 and 2004, mainly for childhood cancer. In 23 patients, the conditioning regimen consisted of high-dose chemotherapy and TBI (TBI+). In the other 17 patients, who did not receive TBI (TBI−), HCT was performed after high-dose chemotherapy alone.
Results
Overall, 34% of patients in the TBI+ group showed growth hormone deficiency, compared with none of the patients in the TBI− group (P < 0.05). Leydig cell failure was found in 23% of patients in the TBI+ group and in 0% of the patients in the TBI− group. Elevated FSH levels, suggesting spermatogenesis damage, were found in all the patients receiving TBI and in 36% of the patients in the TBI− group (P < 0.001). Also, primary hypothyroidism was more common in TBI+ (34%) than in TBI− (5.8%) patients (P < 0.05).
Conclusions
Our data indicate that endocrine late effects after HCT are more frequent in patients who received TBI, an observation that should be considered, even if the choice of the conditioning regimen is determined by the underlying condition in most cases.
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References
Acharya S, Sarafoglou K, LaQuaglia M, Lindsley S, Gerald W, Wollner N, Tan C, Sklar C (2003) Thyroid neoplasms after therapeutic radiation for malignancies during childhood or adolescence. Cancer 97:2397–2403
Baker KS, Nes KK, Weisdorf D, Francisco L, Sun C-L, Forman S, Bhatia S (2010) Late effects in survivors of acute leukemia treated with hematopoietic cells transplantation: a report from the bone marrow transplant survivor study. Leukemia 24:2039–2047
Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM (2006) Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 91:1995–2010
Brennan BMD, Shalet SM (2002) Endocrine late effects after bone marrow transplantation. Br J Haematol 118:58–66
Bresters D, Van Gils ICM, Kollen WJW, Baal LM, Oostdijk W, Van der Bom JG, Egeler RM (2010) High burden of late effects after haematopoietic stem cell transplantation in childhood: a single center study. Bone Marrow Transplant 45:79–85
Brignardello E, Corrias A, Isolato G, Palestini N, Cordero di Montezemolo L, Fagioli F, Boccuzzi G (2008) Ultrasound screening for thyroid carcinoma in childhood cancer survivors: a case series. JCEM 93:4840–4843
Cohen A, Rovelli A, van Lint MT, Merlo F, Gaiero A, Mulas A, Balduzzi A, Corti P, Uderzo C, Bacigalupo A (2001) Secondary thyroid carcinoma after allogeneic bone marrow transplantation during childhood. Bone Marrow Transplant 28:1125–1128
Cohen A, Rovelli A, Merlo DF, van Lint MT, Lanino E, Bresters D, Ceppi M, Bocchini V, Tichelli A, Socié G (2007) Risk for secondary thyroid carcinoma after hematopoietic stem-cell transplantation: an EBMT late effects working party study. J Clin Oncol 25:2449–2454
Darzy KH, Shalet SM (2005) Hypopituitarism after cranial irradiation. J Endocrinol Invest 28:78–87
Faraci M, Barra S, Cohen A, Lanino E, Grisolia F, Miano M, Foppiano F (2005) Very late nonfatal consequences of fractionated TBI in children undergoing bone marrow transplantation. Int J Rad Oncol Biol Phys 63:1568–1575
Howell SJ, Shalet SM (2005) Spermatogenesis after cancer treatment: damage and recovery. J Nat Cancer Inst Monogr 34:12–17
Huddart RA, Norman A, Moynihan C, Horwich A, Parker C, Nicholls E, Dearnaley DP (2005) Fertility gonadal and sexual function in survivors of testicular cancer. Br J Cancer 93:200–207
Ishida Y, Sakamoto N, Kamibeppu K, Kakee N, Iwai T, Ozono S, Maeda N, Okamura J, Asami K, Inada H, Honda M, Horibe K (2010) Late effects and quality of life of childhood cancer survivors: part 2. Impact of radiotherapy. Int J Hematol 92:95–104
Ishiguro H, Yasuda Y, Tomita Y, Shinagawa T, Shimizu T, Morimoto T, Hattori K, Matsumoto M, Inoue H, Yabe H, Yabe M, Shinohara O, Long-term KatoS (2004) Follow-up of thyroid function in patients who received bone marrow transplantation during childhood, adolescence. J Clin Endocrinol Metab 89:5981–5986
Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ (2006) Cancer statistics 2006. CA Cancer J Clin 56:106–130
Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, Friedman DL, Marina N, Hobbie W, Kadan-Lottick NS, Schwartz CL, Leisenring W, Robison LL (2006) Childhood cancer survivor study. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 355:1572–1582
Perkins JL, Kunin-Batson AS, Youngren NM, Ness KK, Ulrich KJ, Hansen MJ, Petryk A, Steinberger J, Anderson FS, Baker K (2007) Long-term follow-up of children who underwent hematopoietic cell transplant (HCT) for AML or ALL at less than 3 years of age. Pediatr Blood Cancer 49:958–963
Romerius P, Ståhl O, Moëll C, Relander T, Cavallin-Ståhl E, Wiebe T, Lundberg Giwercman Y, Giwercman A (2009) Hypogonadism risk in men treated for childhood cancer. J Clin Endocrinol Metab 94:4180–4186
Rose SR, Ross JL, Uriarte M, Barnes KM, Cassorla FG, Cutler GB Jr (1988) The advantage of measuring stimulated as compared with spontaneous growth hormone levels in the diagnosis of growth hormone deficiency. N Engl J Med 28:201–207
Rutter MM, Rose SR (2007) Long-term endocrine sequelae of childhood cancer. Curr Opin Pediatr 19:480–487
Sanders JE, GuThrie KA, Hoffmeister PA, Woolfrey AE, Carpenter PA, Appelbaum FR (2005) Final adult heights of patient who received hematopoietic cell transplantation in childhood. Blood 105:1348–1354
Schmiegelow M, Feldt-Rasmussen U, Rasmussen AK, Poulsen HS, Müller J (2003) A population-based study of thyroid function after radiotherapy and chemotherapy for a childhood brain tumor. J Clin Endocrinol Metab 88:136–140
Sigurdson A, Ronckers C, Mertens A, Stovall M, Smith S, Liu Y, Berkow R, Hammond S, Neglia J, Meadows A (2005) Primary thyroid cancer after a first tumour in childhood (the childhood cancer survivor study): a nested case-control study. Lancet 365:2014–2023
The Children’s Oncology Group (2008) Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult. Version 3.0 http://www.survivorshipguidelines.org. Accessed 15 March 2011
Wallace WHB, Thomson AB, Kelsey TW (2003) The radiosensitivity of the human oocyte. Human Reprod 18:117–121
Acknowledgments
We would like to acknowledge U.G.I. (Unione Genitori Italiani contro il tumore dei bambini) that supported Dr. Felicetti trough a research grant.
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We declare that we have no conflict of interest.
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Felicetti, F., Manicone, R., Corrias, A. et al. Endocrine late effects after total body irradiation in patients who received hematopoietic cell transplantation during childhood: a retrospective study from a single institution. J Cancer Res Clin Oncol 137, 1343–1348 (2011). https://doi.org/10.1007/s00432-011-1004-2
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DOI: https://doi.org/10.1007/s00432-011-1004-2