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Late Effects




Bone Marrow Transplant (BMT)

BMT can damage many organ systems due to a combination of:

  • Toxicity related to conditioning regime
    • Radiation therapy (RT)
      • Whole body low dose RT or total body irradiation (TBI) is generally given - sometimes with extra RT given to sites such as brain or testes for ALL relapse in those organs)
    • Chemotherapy
  • Chronic graft versus host disease


These factors lead to the potential for multiple endocrine related late effects:

Growth failure:

Short stature is common in survivors of BMT

  • Due to a combination of:
    • General growth reduction due to RT related hypoplasia
    • Abnormal GH production by the pituitary

Metabolic syndrome:

  • One study found that almost 40% of long-term survivors after HSCT had metabolic syndrome with insufficient GH secretion on provocative testing.  Metabolic syndrome has been found to be associated with insufficient GH secretion. The use of total body irradiation in preparative regimen when child had previously received cranial radiation was biggest risk factor*.   

Thyroid dysfunction:

  • Primary hypothyroidism is very common in survivors of BMT
  • These patients also are at significantly increased risk for the development of thyroid malignancy

Infertility and hypogonadism:

  • Infertility is very common after BMT as many preparative regimes contain both alkylating agents and TBI
  • Hypogonadism is less common and usually related to giving "extra" RT to the gonads in the case of ALL testicular relapse


* Taskinen M, LipsanenNyman M, Tiitinen A, et al: Insufficient growth hormone secretion is associated with metabolic syndrome after allogeneic stem cell transplantation in childhood. Journal of Pediatric Hematology/Oncology 29:529-534, 2007






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