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Bone and hormonal status 10 years post allogeneic bone marrow transplantation

Gubrianska D1Machaczka M2Hassan M1,3Hägglund H4Ljungman P5Palmér M6.

Clin Transplant. 2019 Oct 25:e13742. doi: 10.1111/ctr.13742. [Epub ahead of print]



Bone loss and endocrine dysfunction are potential late complications of allogeneic stem cell transplant (allo-SCT); however, scant information concerning the long-term effects in SCT adult patients is available. In the present study we evaluated bone status, expressed as bone mineral density (BMD), and endocrine functions including PTH, TSH, free T4, testosterone, SHBG, FSH, LH, IGF-1, in 20 adult leukemia patients >10 years after allo-SCT. A low BMD (Z-score <-2.0) was observed in two patients; two patients had osteoporotic fractures and two had a unilateral avascular necrosis of the femoral head. Elevated PTH was observed in 30% of patients and 25-hydroxy vitamin-D (25(OH)D), was low (<50 nmol/L) in 45% of the patients. The majority of the patients had thyroid tests within the reference range while elevated FSH values were present in 8/12 males. We conclude that adult leukemia patients have relatively well-preserved BMD >10 years post allo-SCT. Prophylactic treatment of osteoporosis should be individualized, but control of BMD is necessary for long-term follow-up. Control of PTH and vitamin-D levels before and after allo-SCT is recommended and vitamin D supplementation should be considered if indicated. Estrogen replacement therapy is a routine treatment in females, whereas gonadal function in males requires further investigation