Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Pediatr Transplant. 2021 May;25(3):e13983. doi: 10.1111/petr.13983. Epub 2021 Feb 6.
We have previously demonstrated a 11% incidence of post-transplant de novo thyroid disease, even with a radiation-free RIC regimen. Following the enactment of a universal late effects screening program at our institution, we compared the outcomes of 108 pediatric hematopoietic stem cell transplant recipients after a RIC regimen (n = 33) to those after a MAC regimen (n = 75) during the same time period. Overall, 10% of subjects developed thyroid dysfunction after HSCT, with a median follow-up of 669 days. Seven subjects had primary hypothyroidism prior to HSCT. Of the thirty-one subjects who received RIC, one (3.2%) developed a new thyroid disorder, compared to the nine of sixty-nine (13.0%) subjects who received MAC (p = .167). No significant associations were seen with donor type, graft-vs.-host disease, or total body irradiation. Nine of the 10 subjects who developed thyroid disease after transplant were asymptomatic. Continued follow-up of this contemporary cohort will further delineate risk factors for post-transplant-associated thyroid dysfunction and better inform discussions of transplant-associated sequelae.
我们之前曾报道过，即使采用无放射性RIC 方案，移植后新发甲状腺疾病的发生率仍为 11%。在我们机构实施了一项普遍的晚期效应筛查计划后，我们比较了同一时期接受 RIC 方案（n=33）和 MAC 方案（n=75）的 108 例儿科造血干细胞移植受者的结局。总体而言，10%的受试者在 HSCT 后出现甲状腺功能障碍，中位随访时间为 669 天。7 名受试者在 HSCT 前患有原发性甲状腺功能减退症。在接受 RIC 的 31 名受试者中，有 1 名（3.2%）新发甲状腺疾病，而接受 MAC 的 69 名受试者中有 9 名（13.0%）（p=0.167）。未发现与供体类型、移植物抗宿主病或全身照射有显著相关性。在移植后发生甲状腺疾病的 10 名受试者中，有 9 名无症状。对这一当代队列的进一步随访将进一步明确移植后相关甲状腺功能障碍的危险因素，并更好地告知与移植相关的后果的讨论。
