ECE2022 Rapid Communications Rapid Communications 14: Late Breaking (8 abstracts)
Sapienza University of Rome, Dept. of Experimental Medicine, Roma, Italy
Introduction: With the increasing survival rates from cancer the focus has been shifting towards the adverse sequelae, occurring both acutely, or developing as late effects, deriving from its multimodality treatment.
Aim: We investigated the occurrence of thyroid complications in patients with haematological malignancies treated with chemotherapy, radiotherapy involving the neck and/or haematopoietic stem cell transplantation (HSCT), referred to our endocrine sequelae clinic over the course of 20 years.
Patients and Methods: We prospectively enrolled 343 patients (172 females, 50.1%), with median age at diagnosis of 17 years (range: 1-76), and median follow-up of 12.4 years. Diagnoses were similarly distributed across: acute myeloid leukaemia, acute lymphoblastic leukaemia, chronic myeloid leukaemia, Hodgkins lymphoma, non-Hodgkins lymphomas, myelodysplastic syndromes and multiple myeloma. All patients underwent systemic chemotherapy, radiotherapy involving the neck was needed in 103 patients and 208 subjects received HSCT. We investigated the occurrence of: overall thyroid complications, transient and permanent thyroid dysfunction, low T3 syndrome, thyroid autoimmunity, benign and malignant thyroid nodules using Kaplan-Meier survival analyses and Cox proportional hazards models with bootstrapping.
Results: Overall 58.7% of patients experienced thyroid complications, with a median latency time of 3.7 years. Primary hypothyroidism was encountered in 15.6% and transient hypothyroidism in 6.3% of patients; Cox regression revealed female sex (P=0.008), adult age (P=0.035) and radiotherapy (P< 0.001) as independent predictors. Low T3 syndrome was diagnosed in 10.1% of patients, and female sex and radiotherapy were independent predictors (P=0.027 and 0.009, respectively). Transient hyperthyroidism was found in 2.1%, mostly after neck radiotherapy. Thyroid autoimmunity was encountered in 32%, and adult age at diagnosis (>18 years) was the only independent predictor (P=0.028). Thyroid nodules were encountered in 41.1%, with adult age at diagnosis as the only independent predictor (P=0.032); 5 patients were diagnosed with papillary thyroid carcinomas. With regards to overall thyroid complications, female sex and adult age at diagnosis were associated with the highest risk (P< 0.001 and 0.001, respectively). Neck radiotherapy was associated with an increased risk of complications after a median of 18 years, whereas HSCT was not, after multiple adjustments.
Conclusions: Thyroid comorbidities are highly prevalent among patients treated for haematological malignancies, with specific associations with treatment modality, requiring long-term endocrine follow-up.