Long-term endocrine toxicity of myeloablative treatment followed by autologous bone marrow/blood derived stem cell transplantation in patients with malignant lymphohematopoietic disorders

Abstract

The effect of myeloablative treatment with autologous bone marrow transplantation (ABMT)/autologous blood derived stem cell transplantation (ABSCT) in patients with acute leukemias or lymphomas was studied in 32 adult patients with a mean observation time of 15.8 months after transplantation. The conditioning regimen consisted of hyperfractionated total-body irradiation (TBI) and high-dose cyclophosphamide or the cyclophosphamide, carmustine, and etoposid (CBV) regimen. In all of the female patients, we observed primary ovarian failure requiring estradiol replacement therapy. In all of the male patients, testosterone levels were normal but follicle stimulating hormone (FSH) levels were increased, suggestive of germinal aplasia which was proved by semen analysis in several patients. In contrast to the reports of other groups, we did not find any abnormalities in thyroid function, most likely because TBI was hyperfractionated. Moderate toxicity to the adrenal cortex was noticed and was more pronounced in women than in men. Our results are similar to findings reported after allogeneic bone marrow transplantation, with the exception of normal thyroid function in our patients. These results should be taken into consideration when counseling patients about the long-term consequences of myeloablative treatment. Cryopreservation of semen should be offered to men before myeloablative treatment. Estrogen replacement should be initiated after transplantation in women to prevent adverse effects of long-term ovarian failure.