Avaliação endócrino metabólica, massa óssea e sarcopenia em pacientes submetidos a quimioterapia em alta dose pós transplante autólogo de células tronco hematopoiéticas por linfoma

Abstract

Introduction: In the universe of patients with lymphoma, the recurrence rate after initial chemotherapy is around 30%, with autologous stem cell transplantation being the standard therapy after relapse. It is known the effort to improve the patient’s quality of life, due to the increase in overall survival and progression-free survival. However, there are relevant outcomes during follow up like endocrine, metabolic, body composition and bone complications and these population have a special condition, is often young. Objective: To evaluate the long-term endocrine, metabolic, bone mass, sarcopenia and symptoms of anxiety, depression and stress complications in patients transplanted for lymphoma, who underwent high-dose chemotherapy in the conditioning regimen prior to transplantation. Material and methods: This is a cross-sectional study with patients transplanted for lymphoma over 18 years old. They were invited to participate through telephone contact and attended the University Hospital for laboratory tests, medical evaluation, complementary tests such as bone density and total body composition assessment, in addition to the self-filling of the DASS 21 scale. Results: A total of 39 patients were recruited with a median follow-up time of 30 months (2-180 months), with 25 (64.1%) transplanted for Hodgkin lymphoma. A prevalence similar to that of the Brazilian population was found regarding metabolic comorbidities like diabetes (10.2%), obesity (30.7%) and metabolic syndrome (33.3%). Regarding hormonal changes in women, hypergonadotropic hypogonadism occurred in 70% of those in menarche time, with a median amenorrhea period of 12 months (2-172 months). As for men, infertility, related to treatment, was significant and observed through the measurement of FSH gonadotropin above the upper limit of the method in 81.2% (13 patients). The assessment of sarcopenia was performed according to the updated criteria of the European EWGSOP2 group through total body densitometry, with a frequency found of 15.4%, however, it affected only patients transplanted from 2019 onwards with no severe sarcopenia or sarcopenic obesity. Bone mass changes occurred in 23% (9 patients) in both sexes, however without a history of fragility fractures. Regarding the assessment of the psychological profile, it was carried out through screening using the DASS 21 tool, compared to a control group, that are hematological patients without oncological pathologies however, this group showed significantly anxiety symptoms superior to the transplanted group (p=0.023) and, of the 7 patients who were in treatment for depression, all scored for it on the DASS 21. Conclusion: With the advances in the therapy of patients with lymphoma, survival has been progressively increasing and likewise l o n g t e r m c o m p l i c a t i o n s . Furthermore, there is a highlighting importance of multidisciplinary follow-up and screening of major modifiable risk factors such as overweight, muscle strength, hyperglycemia, hypertension, dyslipidemia, sedentary lifestyle and metabolic syndrome.