The endocrine system is highly susceptible to damage by high-dose chemotherapy and/or irradiation before hematopoietic cell transplantation (HCT) during childhood. The specific endocrine organs most affected by HCT include the thyroid gland, the pituitary, and the gonads. In addition, hormones that support development and stability of the skeletal system are also affected. Insufficiency of thyroid hormone is 1 of the most common late sequelae of HCT, and occurs more often in young children. Deficiency in the pituitary's production of growth hormone is a problem of unique concern to the pediatric population. The reproductive risks of HCT depend on the patient's gender and pubertal status at the time of HCT. Pubertal or gonadal failure frequently occurs, especially in females. Infertility risks for both genders remain high, whereas methods of fertility preservation are limited in all but postpubertal males. Bone health post-HCT can be compromised by low bone mineral density as well as avascular necrosis, but the data on both problems in the pediatric HCT population are limited. In this paper, the current state of knowledge, gaps in that knowledge, and recommendations for future research are addressed in detail for each of these systems.
Bibliographical noteFunding Information:
Financial disclosure: C.C.D., A.P., J.S., and C.G. have nothing to disclose. E.Y.C. would like to disclose a limited financial relationship (<$5000) with Innomed and Biomet, and past research funding from Aastrom Biosciences.
Funding for this work was made possible in part by the following National Institute of Health grants: 1R13CA159788-01 (M.P., K.S.B.), U01HL069254 (M.P.), R01 CA112530-05 (K.S.B.) . The views expressed in this manuscript do not reflect the official policies of the Department of Health and Human Services, nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government. Further support was provided by a generous grant from the St. Baldrick’s Foundation and the Lance Armstrong Foundation, as well as the following pharmaceutical companies: Genzyme, Otsuka America Pharmaceutical, Inc., and Sigma-Tau Pharmaceuticals, Inc. The content is solely the responsibility of the authors and does not necessarily represent the official views of those that provided funding. A.P. thanks Dr. Lynda Polgreen for her helpful comments.
- Growth failure
- Late effects
- Pediatric allogeneic transplantation
- Pediatric autologous transplantation
- Thyroid dysfunction