Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
Fondazione FIRMO Onlus (Italian Foundation for the Research on Bone Diseases), Florence, Italy.
Front Endocrinol (Lausanne). 2023 Jan 12;13:1085315. doi: 10.3389/fendo.2022.1085315. eCollection 2022.
Hematopoietic stem cell transplantation (HSCT) is an established therapeutic strategy for the treatment of malignant (leukemia and lymphoma) and non-malignant (thalassemia, anemia, and immunodeficiency) hematopoietic diseases. Thanks to the improvement in patient care and the development of more tolerable conditioning treatments, which has extended the applicability of therapy to the elderly, a growing number of patients have successfully benefited from HSCT therapy and, more importantly, HSCT transplant-related mortality has consistently reduced in recent years. However, concomitantly to long term patient survival, a growing incidence of late HSCT-related sequelae has been reported, being variably associated with negative effects on quality of life of patients and having a non-negligible impact on healthcare systems. The most predominantly observed HSCT-caused complications are chronic alterations of the endocrine system and metabolism, which endanger post-operative quality of life and increase morbidity and mortality of transplanted patients. Here, we specifically review the current knowledge on HSCT-derived side-effects on the perturbation of mineral metabolism; in particular, the homeostasis of calcium, focusing on current reports regarding osteoporosis and recurrent renal dysfunctions that have been observed in a percentage of HSC-transplanted patients. Possible secondary implications of conditioning treatments for HSCT on the physiology of the parathyroid glands and calcium homeostasis, alone or in association with HSCT-caused renal and bone defects, are critically discussed as well.
造血干细胞移植（HSCT）是治疗恶性（白血病和淋巴瘤）和非恶性（地中海贫血、贫血和免疫缺陷）血液病的一种既定治疗策略。由于患者护理的改善和更耐受的预处理治疗的发展，使治疗方法能够应用于老年人，越来越多的患者成功地从 HSCT 治疗中受益，更重要的是，近年来 HSCT 移植相关死亡率持续降低。然而，随着患者长期生存，越来越多的报道称 HSCT 相关的晚期后遗症发病率增加，这些后遗症与患者生活质量的负面影响有关，并对医疗保健系统产生不可忽视的影响。最常见的 HSCT 引起的并发症是内分泌和代谢的慢性改变，这会危及术后生活质量，并增加移植患者的发病率和死亡率。在这里，我们专门回顾了关于 HSCT 对矿物质代谢紊乱的影响的现有知识；特别是钙的动态平衡，重点关注目前关于骨质疏松症和复发性肾功能障碍的报告，这些在一定比例的 HSC 移植患者中观察到。还批判性地讨论了预处理治疗对甲状旁腺生理学和钙动态平衡的可能的次要影响，无论是单独还是与 HSCT 引起的肾脏和骨骼缺陷有关。
