Late thyroid complications in survivors of childhood acute leukemia. An LEA study

Claire Oudin, Pascal Auquier (), Yves Bertrand (), Philippe Chastagner, Justyna Kanold, Maryline Poiree, Sandrine Thouvenin, Stéphane Ducassou, Dominique Plantaz, Marie-Dominique Tabone, Jean-Hugues Dalle (), Virginie Gandemer, Patrick Lutz, Anne Sirvent, Virginie Villes, Vincent Barlogis, André Baruchel, Guy Leverger, Julie Berbis () and Gerard Michel
Additional contact information
Claire Oudin: Service d'hématologie pédiatrique - Université de la Méditerranée - Aix-Marseille 2 - APHM - Assistance Publique - Hôpitaux de Marseille - TIMONE - Hôpital de la Timone [CHU - APHM]
Pascal Auquier: SPMC - Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants - AMU - Aix Marseille Université - APHM - Assistance Publique - Hôpitaux de Marseille
Yves Bertrand: Hématologie et immunologie pédiatrique - HFME - Hôpital Femme Mère Enfant [CHU - HCL] - HCL - Hospices Civils de Lyon - HCL - Hospices Civils de Lyon - CHU Lyon - IHOPe - Institut d'hématologie et d'oncologie pédiatrique [CHU - HCL] - HCL - Hospices Civils de Lyon
Justyna Kanold: SHOP - Service Hématologie et Oncologie Pédiatrique [CHU Clermont-Ferrand] - CHU Estaing [Clermont-Ferrand] - CHU Clermont-Ferrand - Pôle Femme et Enfant [CHU Clermont-Ferrand] - CHU Estaing [Clermont-Ferrand] - CHU Clermont-Ferrand
Maryline Poiree: Service de Pédiatrie, Unité d'Oncologie et Hématologie Pédiatrique - CHU Nice - Centre Hospitalier Universitaire de Nice
Stéphane Ducassou: Hôpital Pellegrin - CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux - Groupe hospitalier Pellegrin
Dominique Plantaz: Service Hématologie Infantile - CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
Marie-Dominique Tabone: CHU Trousseau [APHP] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - SU - Sorbonne Université
Jean-Hugues Dalle: Hôpital Robert Debré Paris - Hôpital Robert Debré - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
Virginie Gandemer: IGDR - Institut de Génétique et Développement de Rennes - UR - Université de Rennes - CNRS - Centre National de la Recherche Scientifique - Biosit : Biologie - Santé - Innovation Technologique - Structure Fédérative de Recherche en Biologie et Santé de Rennes, Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Patrick Lutz: Service de pédiatrie - CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
Virginie Villes: SPMC - Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants - AMU - Aix Marseille Université - APHM - Assistance Publique - Hôpitaux de Marseille
Vincent Barlogis: Pédiatrie et oncologie pédiatrique [Hôpital de la Timone - APHM] - AMU - Aix Marseille Université - APHM - Assistance Publique - Hôpitaux de Marseille - TIMONE - Hôpital de la Timone [CHU - APHM]
André Baruchel: Service d'hématologie et immunologie pédiatrique - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Robert Debré - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - UPD7 - Université Paris Diderot - Paris 7
Guy Leverger: Hôpital Trousseau - CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
Julie Berbis: SPMC - Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants - AMU - Aix Marseille Université - APHM - Assistance Publique - Hôpitaux de Marseille
Gerard Michel: Pédiatrie et oncologie pédiatrique [Hôpital de la Timone - APHM] - AMU - Aix Marseille Université - APHM - Assistance Publique - Hôpitaux de Marseille - TIMONE - Hôpital de la Timone [CHU - APHM]

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Abstract: Thyroid complications are known side effects of irradiation. However, the risk of such complications in childhood acute leukemia survivors who received either central nervous system irradiation or hematopoietic stem cell transplantation is less described. We prospectively evaluated the incidence and risk factors for thyroid dysfunction and tumors in survivors of childhood acute myeloid or lymphoid leukemia. A total of 588 patients were evaluated for thyroid function, and 502 individuals were assessed for thyroid tumors (median follow-up duration: 12.6 and 12.5 years, respectively). The cumulative incidence of hypothyroidism was 17.3% (95% CI: 14.1-21.1) and 24.6% (95% CI: 20.4-29.6) at 10 and 20 years from leukemia diagnosis, respectively. Patients who received total body irradiation (with or without prior central nervous system irradiation) were at higher risk of hypothyroidism (adjusted HR: 2.87; P=0.04 and 2.79, P=0.01, respectively) as compared with transplanted patients who never received any irradiation. Patients transplanted without total body irradiation who received central nervous system irradiation were also at higher risk (adjusted HR: 3.39; P=0.02). Patients irradiated or transplanted at older than 10 years of age had a lower risk (adjusted HR: 0.61; P=0.02). Thyroid malignancy was found in 26 patients (5.2%). Among them, two patients had never received any type of irradiation: alkylating agents could also promote thyroid cancer. The cumulative incidence of thyroid malignancy was 9.6% (95% CI: 6.0-15.0) at 20 years. Women were at higher risk than men (adjusted HR: 4.74; P=0.002). In conclusion, thyroid complications are frequent among patients who undergo transplantation after total body irradiation and those who received prior central nervous system irradiation. Close monitoring is thus warranted for these patients. Clinicaltrials.gov identifier: NCT 01756599.

Date: 2016-06
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Published in Haematologica, 2016, 101 (6), pp.747-756. ⟨10.3324/haematol.2015.140053⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01482527

DOI: 10.3324/haematol.2015.140053

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