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