MON-453 Endocrine, Bone, and Metabolic Disorders in Adults after Allogeneic Stem-Cell Transplant

Abstract

Introduction Allogeneic hematopoietic stem cell transplantations (allo-HSCT) is often indicated in malignant hematologic diseases. Conditioning regimens, used to reduce the tumor burden and to prevent transplant rejection, are based on chemotherapy alone or combined with total body irradiation (TBI). Endocrine complications are frequent transplant-related side effects. They have been well described in children studies but less in adulthood. Objective To assess retrospectively endocrine, bone and metabolic disorders in adult patients, 12 months after allo-HSCT. Patients & Methods Inclusion criteria were : patients treated with allo-HSCT from 2006 to 2016 for a malignant hematologic disease; adult and in complete remission at exploration. Exclusion criteria were : anteriority of brain radiotherapy and prior HSCT. Twelve months after HSCT, each patient underwent fasting measurement of IGF1, TSH, fT4, FSH, LH, sex steroids, glycemia, insulin level, and lipid profile. Unless contraindication, adrenal and growth hormone functions were assessed with insulin hypoglycemia test. A dual X-ray absorptiometry was also performed. Results During the inclusion period, 249 patients received allo-HSCT at our institution. Among them, 148 stayed in complete remission 12 months after HSCT and 63 have been explored in our department. The study sample consisted of the 45 patients meeting the inclusion/exclusion criteria. 40 patients had insulin hypoglycemia test. Hypopituitarism was observed in 20 patients (44%) (14 GH deficiency, 8 central adrenal deficiency, 2 central hypothyroidism and 1 central hypogonadism). No predictive factor was found. One patient had central adrenal deficiency after 12 Gy TBI regimen without any corticotherapy. Hypothyroidism was observed in 6 patients (13,6 %), evenly distributed in subclinical, overt and central hypothyroidism. The risk of developing hypothyroidism was higher in patients aged less than 30 y/o at transplantation (OR = 8,5). All premenopausal women (n = 16) had premature ovarian failure. Half of the 18 men were suspected to have spermatogenesis disorder (elevated FSH). Five men had elevated LH with normal testosterone, and one had central hypogonadism possibly attributed to his obesity. Bone mineral density (BMD) was decreased in 33 patients (77 %). Twelve (28 %) had osteoporosis. Conditioning regimen with busulfan was protective of BMD decrease (OR = 0,66 [0,5-0,85], P = 0,02). Obesity was more frequent (20 %) than our national prevalence (14 %). There were no increase in insulino-resistance and diabetes prevalences. Twenty patients (45 %) had dyslipidemia, 14 of them hypertriglyceridemia. Conclusion Our study shows a high frequency of endocrine, bone and metabolic disorders 12 months after allo-HSCT during adulthood. Hypopituitarism is more frequent that previously described, using the gold standard of the GH and adrenal function exploration.