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Early and late endocrinologic complications of the hematopoetic stem cell transplantation performed for hematologic malignancies

Year 2012, Volume: 3 Issue: 1, 149 - 156, 01.03.2012
https://doi.org/10.5799/ahinjs.01.2012.01.0134

Abstract

Hematopoietic stem cell transplantation (HSCT) is used for various hematologic malignancies seen in children and adults. There may be several complications before, during, and after the HSCT. Just one of them is endocrinologiccomplications, since endocrine system (particularly the pituitary gland, thyroid gland, adrenal glands, and gonads) is highly sensitive against various stress. Chemotherapy and/or total body irradiation used as preparative regimens and immunosuppressive agents (especially corticosteroids) used for the graft-versus-host disease can cause hormonal disorders. Time elapsed after the HSCT, transplantation type (autologous or allogeneic), preparative regimen choice, age, and gender determines the complications. A multidisciplinary management containing a specialist of endocrinology for these patients is preferred. In this report, we reviewed the endocrinologiccomplications that observed after the HSCT in children and adults referring to the recent literatures.

References

  • Roziakova L, Mladosievicova B. Endocrine late effects after hematopoietic stem cell transplantation. Oncol Res 2010;18(11-12):607-15.
  • Müller J. Impact of cancer therapy on the reproductive axis. Horm Res 2003;59 (1):12-20.
  • Shalitin S, Phillip M, Stein J, Goshen Y, Carmi D, Ya- niv I. Endocrine dysfunction and parameters of the metabolic syndrome after bone marrow transplanta- tion during childhood and adolescence. Bone Marrow Transplant 2006;37(12):1109-17.
  • Niedzielske E, Wojcik D, Barg E, et al. Evaluation of selected endocrine complications in patients treated with auto-and allo-haematopoietic stem cell trans- plantation. Med Wieku Rozwoj 2008; 12(3): 761-6.
  • Chemaitilly W, Sklar C.A. Endocrine complication of hematopoietic stem cell transplantation. Endocrinol Metab Clin North Am 2007;36(4):983-98.
  • Bakker B, Oostdijk W, Bresters D, Walenkamp MJ, Vossen JM, Wit JM. Disturbances of growth and en- docrine function after busulphan-based condition- ing for haematopoietic stem cell transplantation dur- ing infancy and childhood. Bone Marrow Transplant 2004;33(10): 1049-56.
  • Sanders JE, Guthrie KA, Hoffmeister PA, Woolfrey AE, Carpenter PA, Appelbaum FR. Final adult height of patients who received hematopietic stem cell trans- plantationin childhood. Blood 2005;105 (3):1348-54.
  • Sanders J.E. Growth and develpment after hematopoi- etic cell transplant in children. Bone Marrow Trans- plant 2008;41(2):223-7.
  • Nandagopal R, Laverdière C, Mulrooney D, Hudson MM, Meacham L. Endocrine late effects of childhood cancer therapy: a report from the Children’s Oncology Group. Horm Res 2008; 69(2):65-74.
  • Couto-Silva AC, Trivin C, Esperou H, et al. Final height and gonadal function after total body irradiation during childhood. Bone Marrow Transplant 2006;38(6):427- 32.
  • Littley MD, Shalet SM, Beardwell CG, Robinson EL, Sutton ML. Radiation-induced hypopituitarism is dose- dependent. Clin Endocrinol (Oxf) 1989;31(3): 363-73.
  • Couto-Silva AC, Trivin C, Esperou H, Michon J, Fisch- er A, Brauner R. Changes in height, weight, and plas- ma leptin after bone marrow transplantation. Bone Marrow Transplant 2000; 26 (11):1205-10.
  • Hoffman DM, O’Sullivan AJ, Baxter RC, Ho KKY. Di- agnosis of growth-hormone deficiency in adults. Lan- cet 1994; 343(8905):1064-68.
  • Kauppila M, Koskinen P, Irjala K, Remes K, Viikari J. Long term effects of allogeneic bone marrow trans- plantation (BMT) on pitüitary, gonad, thyroid and adre- nal function in adults. Bone Marrow Transplant 1998; 22 (4):331-7.
  • Rose SR, Lustig RH, Pitukcheewanont P, et al. Di- agnosis of hidden central hypothyroidism in survi- vors of childhood cancer. J Clin Endocrinol Metab 1999;84(12): 4472-9.
  • Sarafoglou K, Boulad F, Gillio A, Sklar C. Gonadal function after bone marrow transplantation for acute leukemia during childhood. J Pediatr 1997;130 (2):210-6.
  • Socié G, Salooja N, Cohen A, et al. Nonmalignant late effects after allogeneic stem cell transplantation. Late Effects Working Party of the European Study Group for Blood and Marrow Transplantation. Blood 2003;101 (9):3373-85.
  • Slatter MA, Gennery AR, Cheetham TD, et al. Thyroid dysfunction after bone marrow transplantation for pri- mary immune deficiency without the use of total body irradiation in conditioning. Bone Marrow Transplant 2004;33(9):949-53.
  • Cohen A, Rovelli A, Merlo DF, et al. Risk for second- ary thyroid carcinoma after hematopoietic stem-cell transplantation: an EBMT Late Effects Working Party Study. J Clin Oncol 2007;25(17):2449-54.
  • Au WY, Lie AK, Kung AW, Liang R, Hawkins BR, Kwong YL. Autoimmune thyroid dysfunction after he- matopoietic stem cell transplantation. Bone Marrow Transplant 2005; 35(4): 383-8.
  • Rizzo JD, Wingard JR, Tichelli A, et al. Recommend- ed screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, the Center for Interna- tional Blood and Marrow Transplant Research, and the American Society of Blood and Marrow Transplan- tation. Biol Blood Marrow transplant 2006;12(2):138- 51.
  • Sanders JE. The impact of marrow transplant pre- parative regimens on subsequent growth and devel- opment. The Seattle Marrow Transplant Team. Semin Hematol 1991;28 (3):244-9.
  • Kyriacou C, Kottaridis PD, Eliahoo J, et al. Germ cell damage and Leydig cell insufficiency in recipi- ents of nonmyeloablative transplantation for hae- matological malignancies. Bone Marrow Transplant 2003;31(1):45-50.
  • Howell SJ, Radford JA, Ryder WD, Shalet SM. Tes- ticular function following cytotoxic chemotherapy: evidence of leydig cell insufficiency. J Clin Oncol 1999;17(5):1493-8.
  • Ghavamzadeh A, Larijani B, Jahani M, Khoshniat M, Bahar B, Tabatabaei O. Thyroid, parathyroid, gonadal, and pancreatic beta-cell function after bone marrow transplantation with chemotherapy-only conditioning. Transplant Proc 2003;35(8):3101-4.
  • Sanders JE, Hawley J, Levy W, et al. Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation. Blood 1996; 87 (7): 3045-52.
  • Ishiguro H, Yasuda Y, Tomita Y, et al. Gonadal shield- ing to irradiation is effective in protecting testicular growth and function in long-term survivors of bone marrow transplantation during childhood or adoles- cence. Bone Marrow Transplant 2007;39(8):483-90.
  • Chatterjee R, Kottaridis PD. Treatment of gonadal damage in recipients of allogeneic or autologous transplantation for haematological malignancies. Bone Marrow Transplant 2002; 30 (10):629-35.
  • Kauppila M, Viikari J, Irjala K, Koskinen P, Remes K. The hypothalamus-pituitary-gonad axis and testicular function in male patients after treatment for haema- tological malignancies. J Intern Med 1998; 244(5): 411-6.
  • Somali M, Mpatakoias V, Avramides A, et al. Func- tion of thehypothalamic-pituitary-gonadal axis in long- terme survivors of hematopoietic stem cell transplan- tation for hematological diseases. Gynecol Endocrinol 2005; 21(1):18-26.
  • Jung MH, Cho KS, Lee JW, et al. Endocrine compli- cations after hematopoietic stem cell transplantation during childhood and adolescence. J Korean Med Sci 2009;24(6):1071-7.
  • Claessens JJ, Beerendonk CC, Schattenberg AV. Quality of life, reproduction and sexuality after stem cell transplantation with partially T-cell-depleted grafts and after conditioning with a regimen including to- tal body irradiation. Bone Marrow Transplant 2006 ;37(9):831-6.
  • Tauchmanovà L, Selleri C, Rosa GD, et al. High prev- alence of endocrine dysfunction in long term survivors after allogeneic bone marrow transplantation for he- matologic diseases. Cancer 2002;95 (5):1076-84.
  • Sklar C. Growth and endocrine disturbances after bone marrow transplantation in childhood. Acta Pae- diatr Suppl. 1995;411: 57-61.
  • Nakagawa K, Kanda Y, Yamashita H, et al. Preserva- tion of ovarian function by ovarian shielding when un- dergoing total body irradiation for hematopoietic stem cell transplantation: a report of two successful cases. Bone Marrow Transplant 2006;37(6):583-7.
  • Holm K, Nysom K, Brocks V, Hertz H, Jacobsen N, Müller J. Ultrasound Bdmode changes in the uterus and ovaries and Doppler changes in the uterus after total body irradiation and allogeneic bone marrow transplantation in childhood. Bone Marrow Transplant 1999; 23(3): 259-63.
  • Ebeling PR. Approach to the patient with transplan- tation-related bone loss. J Clin Endocrinol Metab 2009;94(5):1483-90.
  • Lee WY, Cho SW, Oh ES, et al. The effect of bone marrow transplantation on the osteoblastic differentia- tion of human bone marrow stromal cells. J Clin Endo- crinol Metab 2002;87 (1):329-35.
  • Kerschan-Schindl K, Mitterbauer M, Füreder W, et al. Bone metabolism in patients more than five years af- ter bone marrow transplantation. Bone Marrow Trans- plant 2004;34(6):491-6.
  • Mattano LA Jr. Strategic approachhes to osteoporosis in transplantation. Pediatr Transplant 2004;8 (Suppl 5):51-5.
  • Facon T, Bensadoun RJ, Blanc JL, et al. Osteonecro- sis of the jaw and biphosphonates in oncology. Bull Cancer 2008; 95(4): 413-8.
  • Annaloro C, Usardi P, Airaghi L, et al. Prevalence of metabolicsyndrome in long-term survivors of hemato- poietic stem cell transplantation. Bone Marrow Trans- plant 2008;41(9): 797-804.
  • Majhail NS, Flowers ME, Ness KK, et al. High preva- lance of metabolic syndrome after allogeneic hemato- poietic cell transplantation. Bone marrow Transplant 2009;43 (1):49-54.
  • Baker KS, Ness KK, Steinberger J, et al. Diabetes, hypertension, and cardiovascular events in survivors of HCT: A report from the bone marrow transplantation survivor study. Blood 2007;109 (4):1765-72.
  • Büyükavcı M, Çetingül N, Darcan Ş, Kantar M, Kavaklı K. Late Endocrine Side Effects in Children with Acute Leukemia. Turk J Hematol 2007; 24 (1): 8-13.
  • Gözdaşoğlu S, Aksoylar S, Berberoğlu M, et al. en- docrinologic late effects of chemoradiotherapy in pe- diatric acute leukemia. Turk J Haematol 2002;19 (2): 293-301.

Hematolojik maligniteli olgularda kök hücre transplantasyonu sonrası erken ve geç dönemde ortaya çıkan endokrinolojik komplikasyonlar

Year 2012, Volume: 3 Issue: 1, 149 - 156, 01.03.2012
https://doi.org/10.5799/ahinjs.01.2012.01.0134

Abstract

Hematopoietik kök hücre transplantasyonu (HSCT: Hematopoietic stem cell transplantation) çocuklarda ve erişkinlerdeki çeşitli hematolojik malignitelerintedavisinde kullanılmaktadır. Kök hücre nakli öncesi, nakil esnasında ve sonrasında çeşitli komplikasyonlarla karşılaşılabilir. Bunlardan birisi de endokrinolojik komplikasyonlardır. Endokrinolojik sisteme (özellikle pituiterbez, tiroid bez, adrenal bez ve gonadlar) ait hücreler oldukça hassas hücrelerdir. Transplantasyon öncesi hazırlık rejiminde kullanılan kemoterapi (KT) ve/veya total vücut ışınlaması (TBI: Total body irradiation), daha sonra graftversus host hastalığı(GVHD: Graft versus host disease) nedeniyle başta kortikosteroidler olmak üzere kullanılan immunsupresif ilaçlar erken veya geç dönemde çeşitli hormonal bozukluklara neden olabilmektedir. Kök hücre naklinden sonra geçen süre, transplantasyon tipi (otologveya allojenik) ve hazırlamada kullanılan rejim (KT ve TBI), yaş ve cinsiyet gelişebilecek hormonalbozukluğun tipi ve şiddetini belirleyen faktörlerdir. İçinde hematoloji ve endokrinoloji uzmanlarının da olduğu multidisiplinerbir ekibin kurulması endokrinolojik komplikasyonların erken tanı ve tedavisinde yararlı olacaktır. Bu derleme yazımızda, çocuklarda ve erişkinlerde hematolojikmalignitelerin HSCT ile tedavisinden sonra, erken ve geç dönemde sık gelişen endokrinolojik komplikasyonlar ve tedavileri güncel literatür bilgileri ışığında gözden geçirildi.

References

  • Roziakova L, Mladosievicova B. Endocrine late effects after hematopoietic stem cell transplantation. Oncol Res 2010;18(11-12):607-15.
  • Müller J. Impact of cancer therapy on the reproductive axis. Horm Res 2003;59 (1):12-20.
  • Shalitin S, Phillip M, Stein J, Goshen Y, Carmi D, Ya- niv I. Endocrine dysfunction and parameters of the metabolic syndrome after bone marrow transplanta- tion during childhood and adolescence. Bone Marrow Transplant 2006;37(12):1109-17.
  • Niedzielske E, Wojcik D, Barg E, et al. Evaluation of selected endocrine complications in patients treated with auto-and allo-haematopoietic stem cell trans- plantation. Med Wieku Rozwoj 2008; 12(3): 761-6.
  • Chemaitilly W, Sklar C.A. Endocrine complication of hematopoietic stem cell transplantation. Endocrinol Metab Clin North Am 2007;36(4):983-98.
  • Bakker B, Oostdijk W, Bresters D, Walenkamp MJ, Vossen JM, Wit JM. Disturbances of growth and en- docrine function after busulphan-based condition- ing for haematopoietic stem cell transplantation dur- ing infancy and childhood. Bone Marrow Transplant 2004;33(10): 1049-56.
  • Sanders JE, Guthrie KA, Hoffmeister PA, Woolfrey AE, Carpenter PA, Appelbaum FR. Final adult height of patients who received hematopietic stem cell trans- plantationin childhood. Blood 2005;105 (3):1348-54.
  • Sanders J.E. Growth and develpment after hematopoi- etic cell transplant in children. Bone Marrow Trans- plant 2008;41(2):223-7.
  • Nandagopal R, Laverdière C, Mulrooney D, Hudson MM, Meacham L. Endocrine late effects of childhood cancer therapy: a report from the Children’s Oncology Group. Horm Res 2008; 69(2):65-74.
  • Couto-Silva AC, Trivin C, Esperou H, et al. Final height and gonadal function after total body irradiation during childhood. Bone Marrow Transplant 2006;38(6):427- 32.
  • Littley MD, Shalet SM, Beardwell CG, Robinson EL, Sutton ML. Radiation-induced hypopituitarism is dose- dependent. Clin Endocrinol (Oxf) 1989;31(3): 363-73.
  • Couto-Silva AC, Trivin C, Esperou H, Michon J, Fisch- er A, Brauner R. Changes in height, weight, and plas- ma leptin after bone marrow transplantation. Bone Marrow Transplant 2000; 26 (11):1205-10.
  • Hoffman DM, O’Sullivan AJ, Baxter RC, Ho KKY. Di- agnosis of growth-hormone deficiency in adults. Lan- cet 1994; 343(8905):1064-68.
  • Kauppila M, Koskinen P, Irjala K, Remes K, Viikari J. Long term effects of allogeneic bone marrow trans- plantation (BMT) on pitüitary, gonad, thyroid and adre- nal function in adults. Bone Marrow Transplant 1998; 22 (4):331-7.
  • Rose SR, Lustig RH, Pitukcheewanont P, et al. Di- agnosis of hidden central hypothyroidism in survi- vors of childhood cancer. J Clin Endocrinol Metab 1999;84(12): 4472-9.
  • Sarafoglou K, Boulad F, Gillio A, Sklar C. Gonadal function after bone marrow transplantation for acute leukemia during childhood. J Pediatr 1997;130 (2):210-6.
  • Socié G, Salooja N, Cohen A, et al. Nonmalignant late effects after allogeneic stem cell transplantation. Late Effects Working Party of the European Study Group for Blood and Marrow Transplantation. Blood 2003;101 (9):3373-85.
  • Slatter MA, Gennery AR, Cheetham TD, et al. Thyroid dysfunction after bone marrow transplantation for pri- mary immune deficiency without the use of total body irradiation in conditioning. Bone Marrow Transplant 2004;33(9):949-53.
  • Cohen A, Rovelli A, Merlo DF, et al. Risk for second- ary thyroid carcinoma after hematopoietic stem-cell transplantation: an EBMT Late Effects Working Party Study. J Clin Oncol 2007;25(17):2449-54.
  • Au WY, Lie AK, Kung AW, Liang R, Hawkins BR, Kwong YL. Autoimmune thyroid dysfunction after he- matopoietic stem cell transplantation. Bone Marrow Transplant 2005; 35(4): 383-8.
  • Rizzo JD, Wingard JR, Tichelli A, et al. Recommend- ed screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, the Center for Interna- tional Blood and Marrow Transplant Research, and the American Society of Blood and Marrow Transplan- tation. Biol Blood Marrow transplant 2006;12(2):138- 51.
  • Sanders JE. The impact of marrow transplant pre- parative regimens on subsequent growth and devel- opment. The Seattle Marrow Transplant Team. Semin Hematol 1991;28 (3):244-9.
  • Kyriacou C, Kottaridis PD, Eliahoo J, et al. Germ cell damage and Leydig cell insufficiency in recipi- ents of nonmyeloablative transplantation for hae- matological malignancies. Bone Marrow Transplant 2003;31(1):45-50.
  • Howell SJ, Radford JA, Ryder WD, Shalet SM. Tes- ticular function following cytotoxic chemotherapy: evidence of leydig cell insufficiency. J Clin Oncol 1999;17(5):1493-8.
  • Ghavamzadeh A, Larijani B, Jahani M, Khoshniat M, Bahar B, Tabatabaei O. Thyroid, parathyroid, gonadal, and pancreatic beta-cell function after bone marrow transplantation with chemotherapy-only conditioning. Transplant Proc 2003;35(8):3101-4.
  • Sanders JE, Hawley J, Levy W, et al. Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation. Blood 1996; 87 (7): 3045-52.
  • Ishiguro H, Yasuda Y, Tomita Y, et al. Gonadal shield- ing to irradiation is effective in protecting testicular growth and function in long-term survivors of bone marrow transplantation during childhood or adoles- cence. Bone Marrow Transplant 2007;39(8):483-90.
  • Chatterjee R, Kottaridis PD. Treatment of gonadal damage in recipients of allogeneic or autologous transplantation for haematological malignancies. Bone Marrow Transplant 2002; 30 (10):629-35.
  • Kauppila M, Viikari J, Irjala K, Koskinen P, Remes K. The hypothalamus-pituitary-gonad axis and testicular function in male patients after treatment for haema- tological malignancies. J Intern Med 1998; 244(5): 411-6.
  • Somali M, Mpatakoias V, Avramides A, et al. Func- tion of thehypothalamic-pituitary-gonadal axis in long- terme survivors of hematopoietic stem cell transplan- tation for hematological diseases. Gynecol Endocrinol 2005; 21(1):18-26.
  • Jung MH, Cho KS, Lee JW, et al. Endocrine compli- cations after hematopoietic stem cell transplantation during childhood and adolescence. J Korean Med Sci 2009;24(6):1071-7.
  • Claessens JJ, Beerendonk CC, Schattenberg AV. Quality of life, reproduction and sexuality after stem cell transplantation with partially T-cell-depleted grafts and after conditioning with a regimen including to- tal body irradiation. Bone Marrow Transplant 2006 ;37(9):831-6.
  • Tauchmanovà L, Selleri C, Rosa GD, et al. High prev- alence of endocrine dysfunction in long term survivors after allogeneic bone marrow transplantation for he- matologic diseases. Cancer 2002;95 (5):1076-84.
  • Sklar C. Growth and endocrine disturbances after bone marrow transplantation in childhood. Acta Pae- diatr Suppl. 1995;411: 57-61.
  • Nakagawa K, Kanda Y, Yamashita H, et al. Preserva- tion of ovarian function by ovarian shielding when un- dergoing total body irradiation for hematopoietic stem cell transplantation: a report of two successful cases. Bone Marrow Transplant 2006;37(6):583-7.
  • Holm K, Nysom K, Brocks V, Hertz H, Jacobsen N, Müller J. Ultrasound Bdmode changes in the uterus and ovaries and Doppler changes in the uterus after total body irradiation and allogeneic bone marrow transplantation in childhood. Bone Marrow Transplant 1999; 23(3): 259-63.
  • Ebeling PR. Approach to the patient with transplan- tation-related bone loss. J Clin Endocrinol Metab 2009;94(5):1483-90.
  • Lee WY, Cho SW, Oh ES, et al. The effect of bone marrow transplantation on the osteoblastic differentia- tion of human bone marrow stromal cells. J Clin Endo- crinol Metab 2002;87 (1):329-35.
  • Kerschan-Schindl K, Mitterbauer M, Füreder W, et al. Bone metabolism in patients more than five years af- ter bone marrow transplantation. Bone Marrow Trans- plant 2004;34(6):491-6.
  • Mattano LA Jr. Strategic approachhes to osteoporosis in transplantation. Pediatr Transplant 2004;8 (Suppl 5):51-5.
  • Facon T, Bensadoun RJ, Blanc JL, et al. Osteonecro- sis of the jaw and biphosphonates in oncology. Bull Cancer 2008; 95(4): 413-8.
  • Annaloro C, Usardi P, Airaghi L, et al. Prevalence of metabolicsyndrome in long-term survivors of hemato- poietic stem cell transplantation. Bone Marrow Trans- plant 2008;41(9): 797-804.
  • Majhail NS, Flowers ME, Ness KK, et al. High preva- lance of metabolic syndrome after allogeneic hemato- poietic cell transplantation. Bone marrow Transplant 2009;43 (1):49-54.
  • Baker KS, Ness KK, Steinberger J, et al. Diabetes, hypertension, and cardiovascular events in survivors of HCT: A report from the bone marrow transplantation survivor study. Blood 2007;109 (4):1765-72.
  • Büyükavcı M, Çetingül N, Darcan Ş, Kantar M, Kavaklı K. Late Endocrine Side Effects in Children with Acute Leukemia. Turk J Hematol 2007; 24 (1): 8-13.
  • Gözdaşoğlu S, Aksoylar S, Berberoğlu M, et al. en- docrinologic late effects of chemoradiotherapy in pe- diatric acute leukemia. Turk J Haematol 2002;19 (2): 293-301.
There are 46 citations in total.

Details

Primary Language Turkish
Journal Section Collection
Authors

Osman Yokuş This is me

Murat Albayrak This is me

Publication Date March 1, 2012
Published in Issue Year 2012 Volume: 3 Issue: 1

Cite

APA Yokuş, O., & Albayrak, M. (2012). Hematolojik maligniteli olgularda kök hücre transplantasyonu sonrası erken ve geç dönemde ortaya çıkan endokrinolojik komplikasyonlar. Journal of Clinical and Experimental Investigations, 3(1), 149-156. https://doi.org/10.5799/ahinjs.01.2012.01.0134
AMA Yokuş O, Albayrak M. Hematolojik maligniteli olgularda kök hücre transplantasyonu sonrası erken ve geç dönemde ortaya çıkan endokrinolojik komplikasyonlar. J Clin Exp Invest. March 2012;3(1):149-156. doi:10.5799/ahinjs.01.2012.01.0134
Chicago Yokuş, Osman, and Murat Albayrak. “Hematolojik Maligniteli Olgularda kök hücre Transplantasyonu Sonrası Erken Ve Geç dönemde Ortaya çıkan Endokrinolojik Komplikasyonlar”. Journal of Clinical and Experimental Investigations 3, no. 1 (March 2012): 149-56. https://doi.org/10.5799/ahinjs.01.2012.01.0134.
EndNote Yokuş O, Albayrak M (March 1, 2012) Hematolojik maligniteli olgularda kök hücre transplantasyonu sonrası erken ve geç dönemde ortaya çıkan endokrinolojik komplikasyonlar. Journal of Clinical and Experimental Investigations 3 1 149–156.
IEEE O. Yokuş and M. Albayrak, “Hematolojik maligniteli olgularda kök hücre transplantasyonu sonrası erken ve geç dönemde ortaya çıkan endokrinolojik komplikasyonlar”, J Clin Exp Invest, vol. 3, no. 1, pp. 149–156, 2012, doi: 10.5799/ahinjs.01.2012.01.0134.
ISNAD Yokuş, Osman - Albayrak, Murat. “Hematolojik Maligniteli Olgularda kök hücre Transplantasyonu Sonrası Erken Ve Geç dönemde Ortaya çıkan Endokrinolojik Komplikasyonlar”. Journal of Clinical and Experimental Investigations 3/1 (March 2012), 149-156. https://doi.org/10.5799/ahinjs.01.2012.01.0134.
JAMA Yokuş O, Albayrak M. Hematolojik maligniteli olgularda kök hücre transplantasyonu sonrası erken ve geç dönemde ortaya çıkan endokrinolojik komplikasyonlar. J Clin Exp Invest. 2012;3:149–156.
MLA Yokuş, Osman and Murat Albayrak. “Hematolojik Maligniteli Olgularda kök hücre Transplantasyonu Sonrası Erken Ve Geç dönemde Ortaya çıkan Endokrinolojik Komplikasyonlar”. Journal of Clinical and Experimental Investigations, vol. 3, no. 1, 2012, pp. 149-56, doi:10.5799/ahinjs.01.2012.01.0134.
Vancouver Yokuş O, Albayrak M. Hematolojik maligniteli olgularda kök hücre transplantasyonu sonrası erken ve geç dönemde ortaya çıkan endokrinolojik komplikasyonlar. J Clin Exp Invest. 2012;3(1):149-56.