Diabetes mellitus after allogeneic hematopoietic stem cell transplantation

Endocrine Challenges and Metabolic Profile in Recipients of Allogeneic Haematopoietic Stem Cell Transplant: A Cross-Sectional Study from Southern India

Although haematopoietic stem cell transplant has been successfully employed in the cure of several malignant and non-malignant conditions, survivors often suffer from delayed effects involving the endocrine system and cardio-metabolic risk factors. In this cross-sectional study, we aimed to assess the prevalence of endocrine dysfunction and alterations in metabolic profile in 63 recipients of allogeneic stem cell transplantation as compared to 65 age, sex and body mass index matched controls. Hypogonadism emerged as the most prevalent endocrinopathy, present in 23/60 (38.3%) of subjects, followed by overt and subclinical hypothyroidism in 10/63 (15.9%) of cases. The metabolic parameters, that included plasma glucose and lipid profile were not significantly different between cases and controls. However, insulin resistance, as assessed by surrogate markers employing HOMA IR (3.82 vs. 1.97) and QUICKI (0.338 vs. 0.373) was significantly higher among cases than in controls (P < 0.05). Abnormal glucose tolerance was observed in about one-third of the study cohort. The prevalence of overt diabetes (7%) was similar to that in the general population across India (8%); the prevalence of pre-diabetes (21%) was however considerably higher than the national average of 10%. Thus, although the process of haematopoietic stem cell transplant is often curative for the primary haematological disease, it may be associated with various delayed effects on the endocrine system and metabolic profile. Therefore, it is imperative that recipients be screened for the potential development of these late effects subsequent to the transplantation procedure.