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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.
Osteoporosis - 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