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Table 10 Screening of the most frequent endocrine complications after allo-HSCT

From: Management of endocrino-metabolic dysfunctions after allogeneic hematopoietic stem cell transplantation

Thyroid Disorder

- TSH, free serum T4 at 6 months and yearly

- Clinical thyroid examination yearly

- Sonogram if clinical anomaly

- If abnormalities are detected, consider referral to an endocrinologist

Gonad dysfunction/Fertility

1. before allo-HSCT: conservation must be proposed as possible:

- Man: Sperm collection. After chemotherapy, it is possible if patient is not azoospermic.

- Female: ovary or oocyte freezing ; ovarian blocking by Gn-RH analogs

- Prepubertal: freezing of testicle pulp and ovarian tissu sample.

2. after allo-HSCT (first months): contraception is necessary (see Table 2)

3. after allo-SCT (second period):

- Woman: hormonal assessment and substitution indicated in 6-12 months. Gynecologic evaluation yearly. Be careful between vaginal GVHD and menopausal symptoms.

- For male, dosage of testosterone if symptoms warrant and consider referral to specialist.

4. If pregnancy is discussed: 2 years between allo-HSCT and pregnancy is the minimum required. Patient should be referred to specialist in assisted reproductive technologies/oncofertility.


- Compensate a potential deficiency of calcium and vitamin D, especially if steroids.

- Screen and treat other causes of osteoporosis (hyperthyroidism, hyperparathyroidism, hypogonadism)

- Dual photon densitometry (DEXA): if possible before and at least 1, 5 and 10 year after HSCT.

- Biphosphonate therapy if osteopenia or osteoporoses are established and if steroid therapy >7.5 mg/day is prescribed more than 3 months