Late thyroid toxicity in 153 long-term survivors of allogeneic bone marrow transplantation for acute lymphoblastic leukaemia

• Published in: Bone marrow transplantation (Basingstoke) Vol. 35; no. 10; pp. 991 - 995
• Main Authors: BERGER, C, LE-GALLO, B, MICHEL, G, STEPHAN, J. L, DONADIEU, J, RICHARD, O, DEVERGIE, A, GALAMBRUN, C, BORDIGONI, P, VILMER, E, PLOUVIER, E, PEREL, Y
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.05.2005
• Subjects: Acute lymphoblastic leukemia; Acute lymphocytic leukemia; Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone Marrow Transplantation - adverse effects; Bone marrow, stem cells transplantation. Graft versus host reaction; Busulfan; Care and treatment; Child; Child, Preschool; Children; Complications and side effects; Cyclophosphamide; Cytology; Female; Hematologic and hematopoietic diseases; Humans; Hypothyroidism; Hypothyroidism - etiology; Infant; Infant, Newborn; Irradiation; Leukemia; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Nodules; Patients; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prevention; Prognosis; Radiation; Radiation dosage; Remission; Risk analysis; Risk Factors; Stem cell transplantation; Survival; Survivors; Thyroid; Thyroid cancer; Thyroid diseases; Thyroid gland; Toxicity; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Whole-Body Irradiation - adverse effects; France; Human; ALL; Late; Endocrine gland; Hematology; Toxicity; Acute; Stem cell; Hematopoietic cell; Homograft; Malignant hemopathy; Thyroid gland; Long term; Thyroid function; Dysfunction; children; Lymphoproliferative syndrome; Bone marrow; Graft; Acute lymphocytic leukemia; Child; thyroid dysfunction
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1704945

The purpose of this study was to identify risk factors for hypothyroidism after bone marrow transplantation (BMT) for high-risk or relapsed acute lymphoblastic leukaemia (ALL) in children. In all, 388 children with acute lymphoblastic leukaemia underwent allogeneic bone marrow transplantation between 1984 and 1994. Overall 5-year survival was 54.6%. Thyroid function was assessed in the 153 patients with more than 5 years of follow-up. In total, 16 patients developed uncompensated hypothyroidism (UH) and 46 compensated hypothyroidism (CH) a median of 2.9 and 2.7 years, respectively, after BMT. Thyroid dysfunction-free survival rates were 73.2% after 5 years and 59.2% after 10 years. Three factors were significantly associated with the onset of hypothyroidism, namely age, bone marrow transplantation in second remission, and single-dose total body irradiation (TBI). Ultrasonography of the thyroid showed nodules in 10 of 35 patients. The median time from BMT to nodule detection was 7.8 years. Cytology (n=5) and surgery (n=4) showed no evidence of thyroid cancer. Four of the 14 patients who received cytoreduction without TBI but with busulphan and cyclophosphamide developed UH (n=2) or CH (n=2). We concluded that children who undergo BMT for ALL are at a high risk of subsequent thyroid dysfunction.