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Background: The progressively increasing number of long-term survivors after allogeneic bone marrow transplantation (allo-BMT) led researchers to focus on the early and late complications of this procedure. Endocrine dysfunction occurred mostly in patients who had undergone total body irradiation (TBI) as part of pretransplantation treatment. The extent to which chemotherapy and immune system derangement affect endocrine function in allo-BMT recipients is still unclear., Methods: Forty consecutive patients (21 women, 19 men) with hematologic diseases surviving 12 or more months after allo-BMT from HLA-identical siblings were studied. Patients' age at transplantation ranged from 13 to 45 years and their post-BMT follow-up lasted 12-62 months. The conditioning regimen BUCY2 was employed. Graft versus host disease (GVHD) was observed in the acute form in 13 patients and in the chronic form in 26. The function of hypothalamic-pituitary-gonad, thyroid, somatotrophic, and adrenal axes was assessed., Results: The most common endocrine dysfunction was ovarian insufficiency (95% of women), followed by an increase in follicle-stimulating hormone in 47% of men, indicating spermatogenesis damage. Hormone replacement therapy was contraindicated in three women because of chronic liver GVHD and it was ineffective partially in four others because of reduced intestinal or cutaneous absorption. Thyroid dysfunction occurred in 47.5% of patients and included low T3 syndrome, chronic thyroiditis, and transient subclinical hyperthyroidism and subclinical hypothyroidism. Adrenal function was abnormal in 10%, mostly related to the prolonged corticosteroid treatment. IGF-I was lower than age-reference values in 27% of all patients and in 38% of those with chronic GVHD. Thyroid, adrenal, and IGF-I impairments were more frequent in patients with chronic GVHD than in patients without this disease (P = 0.048)., Conclusions: A high prevalence of endocrine dysfunction was detected in a cohort of allo-BMT recipients not treated by TBI. Although gonadal failure was likely related to intensive myeloablative treatments, thyroid, adrenal, and IGF-I impairments were late events, suggesting that immunosuppressive treatment and immune system derangement may play a role in the development of endocrine dysfunction after allografting., (Copyright 2002 American Cancer Society.)

Background and Objectives: The optimal method for liver biopsy in patients with simultaneous bone marrow and liver impairment has not yet been established. New approaches (e.g. imaging-guided methods) for this procedure are needed. In spite of coagulopathy, immunosuppression, anemia or ascites, we histologically characterized liver damage in a series of bone marrow transplanted patients using color-Doppler ultrasonography, which permits very keen visualization (and assessment) of hepatic parenchyma and vessels, and a fine needle for percutaneous biopsy., Design and Methods: We performed percutaneous liver biopsy using a Menghini-type automatic very fine cutting needle (1.2 mm, 18G) under color ultrasound guidance in 16 bone marrow transplanted adult patients consecutively seen in our units from 1998 to 2001. The patients had clinically defined diffuse serious liver damage; liver biopsy was performed between 3 and 10 months after allogeneic (n= 11) or autologous (n= 5) transplantation., Results: Fifteen patients tolerated the procedure well and had no discomfort, while one patient developed intrahepatic hemorrhage. All liver biopsies were suitable for histologic examination and informative, revealing the specific etiology of liver damage: graft-versus-host disease in six patients, drug toxicity in five, hepatitis C virus acute reactivation in two, and in one each vanishing bile duct syndrome, nodular regenerative hyperplasia and hemochromatosis. Biopsy detected potentially injurious concomitant factors, e.g., occult intrahepatic hepatitis B virus infection and reactivation. Histology radically changed the presumptive clinical diagnosis in 10 of the 16 patients and led to successful treatment changes in six., Interpretation and Conclusions: Percutaneous biopsy with a small cutting needle under color ultrasound guidance carries a low risk of complications and provides reliable information regarding liver histology in critically ill patients, in the early stage after bone marrow transplantation. We suggest including this imaging-guided mini-invasive procedure to the standard work-up of post-transplant liver damage.

Abstract: Background: Frequent endocrine disorders have been reported after allogeneic stem-cell transplant, but data on adult survivors of autologous transplants are still scarce. Methods: In this prospective study we investigated early (at 3 months) and late (at 12 months) endocrine dysfunctions in 95 consecutive autologous stem-cell transplant recipients (47 men and 48 women) aged 16 to 55 years. The functions of the hypothalamic-pituitary-gonadal/thyroid/adrenal/somatotroph axis were evaluated. Results: Three months after the transplant, insulin-like growth factor-1 values were below the normal range in 53 patients (56%); 37 of 40 women (93%) of reproductive age experienced precocious ovarian failure; 39 of 46 men (85%) showed high follicular stimulating hormone, and 17 men (37%) showed low testosterone levels. Adrenal insufficiency occurred in 28 patients (30%) during the peritransplant period after corticosteroid withdrawal. Transient subclinical hyperthyroidism was found in 15 patients (16%). Transient “low T3” syndrome was revealed in 29 patients (31%). Twelve months after the transplant, insulin-like growth factor-1 values were still low in 36 patients (38%). Menstrual cycles resumed in four women; follicular stimulating hormone, luteinizing hormone, and estradiol levels improved in 10 patients. Testosterone was low in only two men (4%). Seminal analysis revealed azoospermia in 32 (91%) of 35 men examined. Subclinical hypothyroidism was found in 11 patients (12%); eight of them had previously received radiotherapy for the upper half of the body. Conclusion: This study documents frequent endocrine disorders during the first year after autologous stem-cell transplant. Despite a tendency to improve, in more than half of the cases, the complications persisted for more than 1 year. Therefore, to diagnose and correct early and late endocrine dysfunctions, endocrine screening is required during the first year in all patients undergoing autografting. [Copyright &y& Elsevier]