Endocrine Complications in Long-Term Survivors of Allogeneic Hematopoietic Stem-Cell Transplantation: Prevalence and Risk Factors

Objective: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) offers a potentially curative treatment for a range of hematologic disorders. However,
long-term survivors of the treatment are increasingly affected by late-onset complications, particularly endocrine dysfunction, which considerably impair quality of
life. This study aimed to establish the prevalence and risk factors of late endocrine complications in patients who survived at least 1 year without disease following
allo-HSCT.
Materials and Methods: We conducted a retrospective cohort analysis of 79 recipients of allo-HSCT at a single tertiary referral center. Patients with disease relapse or
those who died within the first year after allo-HSCT were excluded. Data on demographic and transplant characteristics, graft-versus-host disease, immunosuppressive
therapy, and endocrine outcomes were analyzed. Patients with such conditions before transplantation were excluded from the corresponding outcome analyses. Risk
factors were evaluated using statistical methods.
Results: The median follow-up duration was 38 months. New-onset endocrine complications were observed in a substantial proportion of patients: dyslipidemia
(77.3%), osteopenia or osteoporosis (58.2%), hypogonadism (27.8%), thyroid dysfunction (hypothyroidism or hyperthyroidism: 36.2%), and hypertension (33.5%).
Significant risk factors included female sex, corticosteroid exposure, short-term cyclosporine use, and acute graft-versus-host disease. Avascular necrosis was detected
in 13.9% of patients and associated with bisphosphonate, mycophenolate mofetil, and steroid use.
Conclusion: Endocrine complications are highly prevalent among patients who have survived beyond 1 year after allo-HSCT. Regular and comprehensive endocrine
surveillance is essential, particularly in patients with specific risk factors. Early identification and management of these complications could improve quality of life in
this patient population.