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Impact of allogeneic stem cell transplantation on thyroid function

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Abstract

Purpose

Primary hypothyroidism is a main endocrine complication after allogeneic stem cells transplantation (allo-SCT) in children, but in adults data on post-SCT hypothyroidism are limited. The aims of this observational, cross-sectional study were to assess the prevalence of hypothyroidism in adult allo-SCT recipients according to time from transplantation, and to identify risk factors.

Methods

One hundred and eighty-six patients (M 104; F 82; median age 53.4 years) who underwent allo-SCT between January 2010 and December 2017 were enrolled and divided into three groups, according to time from allo-SCT (1–3 years; 3–5 years; > 5 years). Pre-transplant TSH and fT4 levels were available for all patients. After transplantation, TSH, fT4 and anti-thyroperoxidase antibodies (TPO-Ab) were evaluated.

Results

After a follow-up of 3.7 years, 34 (18.3%) patients developed hypothyroidism, with higher prevalence in females (p < 0.001) and in patients who received matched unrelated donor grafts (p < 0.05). No difference in prevalence was found at different time points. Patients who developed hypothyroidism showed higher rate of TPO-Ab positivity (p < 0.05) and higher pre-transplant TSH levels (median 2.34 µU/ml) compared to those with preserved thyroid function (median 1.53 µU/ml; p < 0.001). Multivariable analysis identified higher pre-transplant TSH levels as a positive predictor of hypothyroidism (p < 0.005). The ROC curve analysis identified a pre-SCT TSH cutoff of 1.84 µU/ml, which can predict hypothyroidism with sensitivity 74.1% and specificity 67.2%.

Conclusions

About one out of four patients developed hypothyroidism after allo-SCT, with a greater incidence in females. Pre-transplant TSH levels seem to predict the onset of post-SCT hypothyroidism.

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Funding

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Authors and Affiliations

  1. Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy

    F. Felicetti, F. Gatti, N. Fortunati, M. Dionisi-Vici & E. Brignardello

  2. Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy

    F. Felicetti, F. Gatti, D. Rosso, N. Fortunati & E. Arvat

  3. Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy

    D. Faraci

  4. Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy

    M. Zavattaro & L. Marinelli

  5. Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy

    M. Zavattaro

  6. Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, USA

    S. Leone

  7. Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy

    J. Gill, C. Dellacasa, A. Busca, L. Giaccone & B. Bruno

  8. Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy

    J. Gill, L. Giaccone & B. Bruno

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  1. F. Felicetti
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  2. F. Gatti
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Correspondence to F. Felicetti.

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On behalf of all authors, the corresponding author states that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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The Authors confirm that the study was approved by the Ethics Committee of Città della Salute e della Scienza Hospital of Turin (number 179/2020) and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Felicetti, F., Gatti, F., Faraci, D. et al. Impact of allogeneic stem cell transplantation on thyroid function. J Endocrinol Invest 46, 1825–1834 (2023). https://doi.org/10.1007/s40618-023-02039-x

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  • DOI: https://doi.org/10.1007/s40618-023-02039-x

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