Ann Pediatr Endocrinol Metab Search


Ann Pediatr Endocrinol Metab > Volume 29(2); 2024 > Article
Jung: Commentary on "Long-term endocrine sequelae after hematopoietic stem cell transplantation in children and adolescents"
Advancements in treatment, along with enhanced supportive care have led to increased rates of survival among pediatric cancer patients [1]. Every year in the United States, approximately 15,000 children between the ages of 0 and 19 are diagnosed with cancer, with over 85% surviving for at least 5 years [2]. The majority of patients experience long-term survival, with over 500,000 in the United States and 30,000 in Korea [2,3]. However, childhood cancer survivors undergo the long-term complications including endocrine disorders commonly.
Endocrine complications encompass growth failure, hypopituitarism, hypogonadism, hypothyroidism, diabetes mellitus, dyslipidemia, obesity, osteoporosis, adrenal insufficiency [2,4]. A systematic review from 3 studies revealed that around 29.0% to 39.1% of childhood cancer survivors treated with cranial radiation therapy experienced growth hormone deficiency, with higher doses of cranial radiation associated with a higher risk [5]. Shin et al. [6] reported a one-year effect of growth hormone replacement without recurrence or occurrence of other tumors in 19 out of 24 growth hormone deficiency patients who survived childhood leukemia.
Childhood cancer survivors demonstrate decreased bone mineral density (BMD) relative to the general population, which can be attributed not only to chemotherapeutic treatments like glucocorticoids and radiation but also to factors like the cancer itself, hormonal insufficiency, inadequate nutrition, and reduced physical activity [7,8]. Jang et al. [9] emphasized the importance of evaluating BMD and monitoring the cumulative dose and duration of glucocorticoids for patients with secondary osteoporosis. According to clinical practical guidelines for optimizing bone health in Korean children and adolescents, sufficient intake of calcium and vitamin D, along with adequate body weight and physical activity, are recommended for childhood cancer survivors. Bisphosphates could also be helpful in increasing BMD [10].
The PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group [11] recommend counseling female childhood, adolescent, and young adult cancer patients who are at potential risk of infertility due to high-dose alkylating agents, ovarian radiotherapy, or hematopoietic stem cell transplantation (HSCT) about fertility preservation options such as oocyte or embryo cryopreservation and harvesting of ovarian tissue for cryopreservation [12]. Before undergoing gonadotoxic chemotherapy or radiotherapy, testicular tissue cryopreservation is primarily offered to young male cancer patients. Moreover, Delgouffe et al. [13] recommend testicular tissue banking for male patients requiring high-risk conditioning therapy before HSCT or bone marrow transplantation.
In this research [14], the authors studied 200 Korean childhood cancer survivors after HSCT and revealed that 67.5% of the patients experienced endocrine complications. Short stature and diabetes mellitus were prevalent among the prepubertal HSCT group, while hypogonadism and osteoporosis were more common among the pubertal HSCT group [14]. Factors such as pubertal age at HSCT, female sex, and steroid use were identified as predictors of increased risk of endocrine complications. Another retrospective study from Spain involving 157 children post-HSCT presented similar risk factors for endocrinopathies including older age at HSCT, pubertal Tanner stage V, chronic graft-vs-host disease, direct gonadal therapy and specific treatments such as radiotherapy and steroids [15]. Figueiredo et al. [16] also reported similar results from a study of 152 Portuguese patients after HSCT during childhood. We need to plan customized surveillance strategies based on the characteristics of the childhood cancer survivors. While this study has the limitation of selection bias because 173 deceased patients were excluded, the extensive duration of the study makes the data significant.


Conflicts of interest

No potential conflict of interest relevant to this article was reported


1. Ghim TT. Time to establish multidisciplinary childhood cancer survivorship programs in Korea. Korean J Hematol 2010;45:84–7.
crossref pmid pmc
2. Bhatia S, Tonorezos ES, Landier W. Clinical care for people who survive childhood cancer: a review. JAMA 2023;330:1175–86.
crossref pmid
3. Lee JW, Yeo Y, Ju HY, Cho HW, Yoo KH, Sung KW, et al. Current status and physicians' perspectives of childhood cancer survivorship in Korea: a nationwide survey of pediatric hematologists/oncologists. J Korean Med Sci 2023;38:e230.
crossref pmid pmc pdf
4. Chueh HW, Yoo JH. Metabolic syndrome induced by anticancer treatment in childhood cancer survivors. Ann Pediatr Endocrinol Metab 2017;22:82–9.
crossref pmid pmc pdf
5. Mulder RL, Kremer LC, van Santen HM, Ket JL, van Trotsenburg AS, Koning CC, et al. Prevalence and risk factors of radiation-induced growth hormone deficiency in childhood cancer survivors: a systematic review. Cancer Treat Rev 2009;35:616–32.
crossref pmid
6. Shin C, Jang MJ, Kim S, Lee JW, Chung NG, Cho B, et al. Short-term effect of growth hormone treatment in childhood leukemia survivors with growth hormone deficiency. Ann Pediatr Endocrinol Metab 2023;28:116–23.
crossref pmid pdf
7. Jin HY, Lee JA. Low bone mineral density in children and adolescents with cancer. Ann Pediatr Endocrinol Metab 2020;25:137–44.
crossref pmid pmc pdf
8. Ahn MB, Suh BK. Bone morbidity in pediatric acute lymphoblastic leukemia. Ann Pediatr Endocrinol Metab 2020;25:1–9.
crossref pmid pmc pdf
9. Jang MJ, Shin C, Kim S, Lee JW, Chung NG, Cho B, et al. Factors affecting bone mineral density in children and adolescents with secondary osteoporosis. Ann Pediatr Endocrinol Metab 2023;28:34–41.
crossref pmid pdf
10. Lee YA, Kwon A, Kim JH, Nam HK, Yoo JH, Lim JS, et al. Clinical practice guidelines for optimizing bone health in Korean children and adolescents. Ann Pediatr Endocrinol Metab 2022;27:5–14.
crossref pmid pmc pdf
11. Mulder RL, Font-Gonzalez A, Hudson MM, van Santen HM, Loeffen EAH, Burns KC, et al. Fertility preservation for female patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021;22:e45–56.
12. Kim H, Kim H, Ku SY. Fertility preservation in pediatric and young adult female cancer patients. Ann Pediatr Endocrinol Metab 2018;23:70–4.
crossref pmid pmc pdf
13. Delgouffe E, Braye A, Goossens E. Testicular tissue banking for fertility preservation in young boys: which patients should be included? Front Endocrinol (Lausanne) 2022;13:854186.
crossref pmid pmc
14. Hwang S, Lee Y, Yoon JH, Kim JH, Kim H, Koh KN, et al. Long-term endocrine sequelae after hematopoietic stem cell transplantation in children and adolescents. Ann Pediatr Endocrinol Metab 2024;29:109–18.
crossref pmid pmc
15. Guemes M, Martin-Rivada A, Bascuas Arribas M, Andres-Esteban EM, Molina Angulo B, Pozo Roman J, et al. Endocrine sequelae in 157 pediatric survivors of hematopoietic stem cell transplantation (HSCT). J Endocr Soc 2022;7:bvac183.
pmid pmc
16. Figueiredo AA, Cavaco D, Damasio I, Maciel J, Pinheiro S, Donato S, et al. Endocrine complications after hematopoietic stem cell transplantation during childhood-Results from a close follow-up in a cohort of 152 patients. Clin Endocrinol (Oxf) 2023;98:202–11.
crossref pmid pdf


Browse all articles >

Editorial Office
501-107, 30 Seocho-daero 74-gil, Seocho-gu, Seoul 06622, Republic of Korea
Tel: +82-2-3471-4268    Fax: +82-2-3471-4269    E-mail:                

Copyright © 2024 by Korean Society of Pediatric Endocrinology.

Developed in M2PI

Close layer
prev next