Work

128: High prevalence of bone loss in long term survivors following allogeneic bone marrow and peripheral blood stem cell transplantation

Year: 2007

Type: article

Abstract: Bone loss (osteopenia/osteoporosis) is a complication following allogeneic stem cell transplantation (SCT). After written consent patients surviving more than three years post-transplant were enrolled in a long-term follow-up study (started in April 2005) which included an annual DEXA scan. Sixty-three patients (median age 35 years) received a fractionated total body irradiation (TBI) (12-13.6 Gy) based myeloablative SCT (MST) and 9 patients (median age 37 years) received a non-TBI non-myeloablative SCT (NST). Age of patients at transplantation ranged from 6 to 66 (median 35 years). The indication for SCT was CML (43), MDS (11), AML (11), ALL (3), CLL (2), SAA (1), and mastocytosis (1). Seventy-two (41M,31F) patients underwent DEXA scanning. Seventy (97%) patients are alive at a median follow-up of 73 months (range 32-155); Acute graft versus host disease (GVHD) occurred in 41 (57%) patients and chronic GVHD in 61 (85%). Twelve (17%) patients at a median follow up 37 (range 32-106 months) were receiving immunosuppressive therapy (IST) for chronic GVHD at the time of analysis. All patients were advised to take vitamin D and calcium supplements after transplantation and all but one female were taking hormone replacement therapy at the time of DEXA scanning. Fifty-three (74%) of patients had bone loss in at least one site measured - 30 (42%) with osteopenia and 23 (32%) with osteoporosis. There was a preponderance of osteopenia and osteoporosis in typical sites such as AP spine (22% and 18%); femoral neck (46% and 6%); and femur (Ward’s area) (38% and 8%); total hip (36% and 1%); but also in the forearm (24% and 13%) likely related to steriod therapy. Mean T score of adult patients was -1.8 ± 0.16 (male -1.9 ± 0.2; female -1.6 ± 0.3); while mean Z score of 5 children (age <18) was -1.6 ± 0.45. Factors associated with significant increase risk of bone loss were: age more than median (p=0.03) and prolonged IST (12/12 vs. 41/60; p=0.017 for bone loss and 8/12 vs.15/60; p=0.008 for osteoporosis). When patient age was analyzed by quartiles, the oldest quartile (range 44-66) was profoundly impacted for osteoporosis (mean T score -2.3 ± 0.25; p=0.016). There was no significant difference in bone loss with regard to sex, stem cell source, disease, TBI dose, acute GVHD, or chronic GVHD. In summary, we found a very high prevalence of bone loss in long term survivors of SCT. Bone loss is associated with older age at transplant and continuing treatment of chronic GVHD.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2006.12.132