Hematolojik maligniteli olgularda kök hücre transplantasyonu sonrası erken ve geç dönemde ortaya çıkan endokrinolojik komplikasyonlar

Hematopoietik kök hücre transplantasyonu (HSCT: Hematopoietic stem cell transplantation) çocuklarda ve erişkinlerdeki çeşitli hematolojik malignitelerin tedavisinde kullanılmaktadır. Kök hücre nakli öncesi, nakil esnasında ve sonrasında çeşitli komplikasyonlarla karşılaşılabilir. Bunlardan birisi de endokrinolojik komplikasyonlardır. Endokrinolojik sisteme (özellikle pituiter bez, tiroid bez, adrenal bez ve gonadlar) ait hücreler oldukça hassas hücrelerdir. Transplantasyon öncesi hazırlık rejiminde kullanılan kemoterapi (KT) ve/veya total vücut ışınlaması (TBI: Total body irradiation), daha sonra graft versus host hastalığı (GVHD: Graft versus host disease) nedeniyle başta kortikosteroidler olmak üzere kullanılan immunsupresif ilaçlar erken veya geç dönemde çeşitli hormonal bozukluklara neden olabilmektedir. Kök hücre naklinden sonra geçen süre, transplantasyon tipi (otolog veya allojenik) ve hazırlamada kullanılan rejim (KT ve TBI), yaş ve cinsiyet gelişebilecek hormonal bozukluğun tipi ve şiddetini belirleyen faktörlerdir. İçinde hematoloji ve endokrinoloji uzmanlarının da olduğu multidisipliner bir ekibin kurulması endokrinolojik komplikasyonların erken tanı ve tedavisinde yararlı olacaktır. Bu derleme yazımızda, çocuklarda ve erişkinlerde hematolojik malignitelerin HSCT ile tedavisinden sonra, erken ve geç dönemde sık gelişen endokrinolojik komplikasyonlar ve tedavileri güncel literatür bilgileri ışığında gözden geçirildi.

Early and late endocrinologic complications of the hematopoetic stem cell transplantation performed for hematologic malignancies

Hematopoietic stem cell transplantation (HSCT) is used for various hematologic malignancies seen in children and adults. There may be several complications before, during, and after the HSCT. Just one of them is endocrinologic complications, since endocrine system (particularly the pituitary gland, thyroid gland, adrenal glands, and gonads) is highly sensitive against various stress. Chemotherapy and/or total body irradiation used as preparative regimens and immunosuppressive agents (especially corticosteroids) used for the graft-versus-host disease can cause hormonal disorders. Time elapsed after the HSCT, transplantation type (autologous or allogeneic), preparative regimen choice, age, and gender determines the complications. A multidisciplinary management containing a specialist of endocrinology for these patients is preferred. In this report, we reviewed the endocrinologic complications that observed after the HSCT in children and adults referring to the recent literatures.

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