Work

Impaired Bone Mineral Density in Pediatric Patients with Chronic Graft-Versus-Host Disease

Year: 2018

Type: article

Abstract: Pediatric allogeneic hematopoietic stem cell transplant (AHSCT) recipients with chronic graft-versus-host disease (cGVHD) are at high risk of endocrinopathies, particularly impaired bone mineral density (BMD). However, rates of BMD impairment in pediatric AHSCT recipients with cGVHD have not been well documented. We describe 33 patients with predominantly moderate to severe cGVHD that were referred to the NIH for the Natural History of Clinical and Biological Factors Determining Outcomes in Chronic Graft-Versus-Host Disease (NCT 0092235) Study and underwent formal BMD assessments via dual-energy X-ray absorptiometry (DEXA). Not surprisingly, we found much higher rates of BMD impairment than previously reported for pediatric AHSCT recipients who were not stratified by presence or absence of cGVHD. Most of our patients, 73%, had a Z-score lower than or equal to -2 in at least one anatomical site. While we expected the rate to be higher than that observed for pediatric AHSCT recipients on studies that did not analyze cGVHD patients separately, the rate was nonetheless extremely high. Furthermore, the rate of occult vertebral compression fractures (VCF) in our patients was 23%. The rates of BMD impairment and VCF in our pediatric cohort were significantly higher than those of the adult AHSCT recipients that were concurrently enrolled on the same study at the NIH and had similar cGVHD severity. We found that older age at cGVHD diagnosis and greater number of systemic therapies were associated with occult VCF. Also, intensity of current immunosuppression negatively impacted spine and total hip BMD in our patients. Our study, while limited by small patient numbers and lack of control AHSCT recipient group without cGVHD, indicates that children with cGVHD are at a greater risk for BMD impairment than previously appreciated. Given rising incidence of cGVHD in AHSCT recipients and our findings, we recommend that pre-AHSCT DEXA be incorporated into routine pediatric pre-transplant screening studies. Having a baseline DEXA study could facilitate longitudinal monitoring of BMD in children who are more susceptible to negative effects of AHSCT on BMD than adults. Also, given high risk of BMD impairment in pediatric AHSCT recipients with cGVHD, such patients should undergo BMD evaluations shortly after developing cGVHD and continue to be monitored, to allow intervention prior to development of the BMD impairment, and its severe manifestation, such as VCF.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2017.12.193