Avascular necrosis of bone after allogeneic hematopoietic cell transplantation in children and adolescents. Biol Blood Marrow Transplant 2014 Apr;20(4):587-92
Date
01/07/2014Pubmed ID
24388803Pubmed Central ID
PMC3959243DOI
10.1016/j.bbmt.2013.12.567Scopus ID
2-s2.0-84895834526 (requires institutional sign-in at Scopus site) 32 CitationsAbstract
We conducted a nested case-control study within a cohort of 6244 patients to assess risk factors for avascular necrosis (AVN) of bone in children and adolescents after allogeneic transplantation. Eligible patients were ≤21 years of age, received their first allogeneic transplant between 1990 and 2008 in the United States, and had survived ≥ 6 months from transplantation. Overall, 160 patients with AVN and 478 control subjects matched by year of transplant, length of follow-up and transplant center were identified. Patients and control subjects were confirmed via central review of radiology, pathology, and/or surgical procedure reports. Median time from transplant to diagnosis of AVN was 14 months. On conditional logistic regression, increasing age at transplant (≥5 years), female gender, and chronic graft-versus-host disease (GVHD) were significantly associated with increased risks of AVN. Compared with patients receiving myeloablative regimens for malignant diseases, lower risks of AVN were seen in patients with nonmalignant diseases and those who had received reduced-intensity conditioning regimens for malignant diseases. Children at high risk for AVN include those within the age group where rapid bone growth occurs as well as those who experience exposure to myeloablative conditioning regimens and immunosuppression after hematopoietic cell transplantation for the treatment of GVHD. More research is needed to determine whether screening strategies specifically for patients at high risk for developing AVN with early interventions may mitigate the morbidity associated with this complication.
Author List
Li X, Brazauskas R, Wang Z, Al-Seraihy A, Baker KS, Cahn JY, Frangoul HA, Gajewski JL, Hale GA, Hsu JW, Kamble RT, Lazarus HM, Marks DI, Maziarz RT, Savani BN, Shah AJ, Shah N, Sorror ML, Wood WA, Majhail NSAuthor
Ruta Brazauskas PhD Associate Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentBone and Bones
Case-Control Studies
Child
Chronic Disease
Female
Graft vs Host Disease
Hematologic Neoplasms
Hematopoietic Stem Cell Transplantation
Humans
Immunosuppressive Agents
Male
Myeloablative Agonists
Osteonecrosis
Risk Factors
Severity of Illness Index
Sex Factors
Time Factors
Transplantation Conditioning
Transplantation, Homologous
Young Adult
