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

Burcu Aslan Candır , Elif Suyani, Zeynep Arzu Yeğin, Zübeyde Nur Özkurt, Merve Pamukçuoğlu, Şahika Zeynep Akı, Gülsan Türköz Sucak

  • Burcu Aslan Candır: DR. ABDURRAHMAN YURTASLAN ANKARA ONKOLOJİ EAH
  • Elif Suyani: Adana Şehir Eğitim ve Araştırma Hastanesi
  • Zeynep Arzu Yeğin: Gazi Üniversitesi Tıp Fakültesi
  • Zübeyde Nur Özkurt: Gazi Üniversitesi Tıp Fakültesi
  • Merve Pamukçuoğlu: Ankara Bilkent Şehir Hastanesi
  • Şahika Zeynep Akı: Ankara Etlik Şehir Hastanesi
  • Gülsan Türköz Sucak: Acıbadem Ataşehir Hastanesi
  • Year : 2026
  • Vol : 42
  • Issue : 3
  •  Page : 234-240
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.
Cite this Article As : Aslan Candir B, Suyani E, Yegin ZA, Ozkurt ZN, Pamukcuoglu M, Aki ZS, Turkoz Sucak G. Endocrine Complications in Long-Term Survivors of Allogeneic Hematopoietic Stem Cell Transplantation: Prevalence and Risk Factors. Selcuk Med J 2026;42(3): 234 240

Download Citation: Endnote/Zotero/Mendeley (RIS) RIS File

Download Citation: BibTeX BibTeX File

Conflict of interest : The authors declare that they have no conflict of interest.
This article is published under the CC BY-NC 4.0 license.
Selcuk Medical Journal
2026, Vol. 42 (3)
ISSN: 1017-6616
E-ISSN: 2149-8059
Received : , Accepted : , Published Online :

References

  1. 1. D'Souza A, Fretham C, Lee SJ, et al. Current Use of and Trends in HematopoieticCell Transplantation in the United States. Biol Blood Marrow Transplant. 2020 Aug;26(8):177-82. doi: 10.1016/j.bbmt.2020.04.013.
  2. 2. Matthews J, Eplin D, Savani B, et al. Managing Endocrine Disorders in Adults After Hematopoietic Stem Cell Transplantation. Clin Hematol Int. 2019 Sep 24;1(4):180-88. doi: 10.2991/chi.d.190917.001.
  3. 3. Paviglianiti A. Endocrine and Metabolic Disorders after Hematopoietic Cell Transplantation. Turk J Haematol. 2020 May 6;37(2):111-15. doi: 10.4274/tjh.galenos.2019.2019.0248.
  4. 4. de Kloet LC, Bense JE, van der Stoep MYEC, et al. Late endocrine effects after hematopoietic stem cell transplantation in children with nonmalignant diseases. Bone Marrow Transplant. 2022 Oct;57(10):1564-72. doi: 10.1038/s41409-022-01755-x.
  5. 5. Shalitin S, Pertman L, Yackobovitch-Gavan M, et al. Endocrine and Metabolic Disturbances in Survivors of Hematopoietic Stem Cell Transplantation in Childhood and Adolescence. Horm Res Paediatr. 2018;89(2):108-21. doi: 10.1159/000486034.
  6. 6. Sholter DE, Armstrong PW. Adverse effects of corticosteroids on the cardiovascular system. Can J Cardiol. 2000 Apr;16(4):505-11.
  7. 7. Hattori T, Murase T, Iwase E, et al. Glucocorticoid-induced hypertension and cardiac injury: effects of mineralocorticoid and glucocorticoid receptor antagonism. Nagoya J Med Sci. 2013 Feb;75(1-2):81-92.
  8. 8. Gunasekaran U, Agarwal N, Jagasia MH, et al. Endocrine complications in long-term survivors after allogeneic stem cell transplant. Semin Hematol. 2012 Jan;49(1):66-72. doi: 10.1053/j.seminhematol.2011.10.010.
  9. 9. Cattoni A, Molinari S, Gaiero A, et al. Thyroid Disorders Following Hematopoietic Stem Cell Transplantation in Childhood: Impact of Conditioning Regimen on Thyroid Dysfunction, Volume Changes, and Occurrence of Nodules. Transplant Cell Ther. 2022 Aug;28(8):506.e1-506.e12. doi: 10.1016/j.jtct.2022.05.040.
  10. 10. Kami M, Tanaka Y, Chiba S, et al. Thyroid function after bone marrow transplantation: possible association between immune-mediated thyrotoxicosis and hypothyroidism. Transplantation. 2001 Feb 15;71(3):406-11. doi: 10.1097/00007890-200102150-00012.
  11. 11. Ishiguro H, Yasuda Y, Tomita Y, et al. Long-term follow-up of thyroid function in patients who received bone marrow transplantation during childhood and adolescence. J Clin Endocrinol Metab. 2004 Dec;89(12):5981-86. doi: 10.1210/jc.2004-0836.
  12. 12. Bar M, Ott SM, Lewiecki EM, et al. Bone Health Management After Hematopoietic Cell Transplantation: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant. 2020 Oct;26(10):1784-02. doi: 10.1016/j.bbmt.2020.07.001.
  13. 13. Tauchmanovà L, Colao A, Lombardi G, et al. Bone loss and its management in long-term survivors from allogeneic stem cell transplantation. J Clin Endocrinol Metab. 2007 Dec;92(12):4536-45. doi: 10.1210/jc.2006-2870.
  14. 14. Campbell S, Sun CL, KurianS, et al. Predictors of avascular necrosis of bone in long-term survivors of hematopoietic cell transplantation. Cancer. 2009 Sep 15;115(18):4127-35. doi: 10.1002/cncr.24474.
  15. 15. Salooja N, Szydlo RM, Socie G, et al. Pregnancy outcomes after peripheral blood or bone marrow transplantation: a retrospective survey. Lancet. 2001 Jul 28;358(9278):271-76. doi: 10.1016/s0140-6736(01)05482-4.
  16. 16. Meirow D. Reproduction post-chemotherapy in young cancer patients. Mol Cell Endocrinol. 2000 Nov 27;169(1-2):123-31. doi: 10.1016/s0303-7207(00)00365-8.
  17. 17. Rotz SJ, Bhatt NS, Hamilton BK, et al. International Recommendations for Screening and Preventative Practices for Long-Term Survivors of Transplantation and Cellular Therapy: A 2023 Update. Transplant Cell Ther. 2024 Apr;30(4):349-85. doi: 10.1016/j.jtct.2023.12.001.
  18. 18. Fred Hutchinson Cancer Center. Long-Term Follow-Up (LTFU) Guidelines for Physicians. 2024. Available at: https://www.fredhutch.org. Accessed May 28, 2025.
  19. 19. National Marrow Donor Program (NMDP). Post-Transplant Long-Term Screening Recommendations. 2023. Available at: https://bethematch.org. Accessed May 28, 2025.
  20. 20. Sikka SC, Bhasin S, Coy DC, et al. Effects of cyclosporine on the hypothalamic-pituitary-gonadal axis in the male rat: mechanism of action. Endocrinology. 1988 Aug;123(2):1069-74. doi: 10.1210/endo-123-2-1069.
  21. 21. Kockx M, Glaros E, Leung B, et al. Low-Density Lipoprotein Receptor-Dependent and Low-Density Lipoprotein Receptor-Independent Mechanisms of Cyclosporin A-Induced Dyslipidemia. Arterioscler Thromb Vasc Biol. 2016 Jul;36(7):1338-49. doi: 10.1161/ATVBAHA.115.307030.