Avascular Necrosis (AVN) Outcomes in Allogeneic Stem Cell Transplant Recipients
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background Avascular necrosis (AVN) is a significant complication affecting quality of life after allogeneic stem cell transplant (alloSCT), with reported incidence rates ranging from 4.3% to 11.8%. However, the physical function, opioid use patterns, and surgical management outcomes for alloSCT recipients with AVN are not well-documented. This study evaluates these factors in a cohort of alloSCT patients. Methods We conducted a retrospective review of adult patients at the University of Kansas Cancer Center who underwent alloSCT from 2003 to 2021 and were diagnosed with AVN. Using the i2b2 query tool, we gathered data on demographics, disease characteristics, transplant details, graft versus host disease (GVHD), joint replacement surgeries, and opioid usage. AVN onset was tracked over time, with high-dose steroids defined as prednisone ≥60 mg/day due to weight variations . Results Our analysis identified 123 patients (Table 1), with a median age of 67 years and a majority being male (54%) and Caucasian (79%). Pre-existing AVN was noted in 7.3% of cases, while 41% had a history of opioid use. The primary diagnoses included acute myeloid leukemia (40%) acute lymphoid leukemia (14%), lymphoma (14%), myelodysplasia (10%), sickle cell disease (2%), multiple myeloma (2%) and other diseases (19%). Most patients (58%) received matched unrelated donor transplants, and 67% underwent myeloablative conditioning . Acute GVHD was prevalent (75%), with 30% experiencing severe cases. Chronic GVHD was also common (85%), with a median duration of 26 months. At AVN diagnosis, 59% of patients were using opioids, with a median time from alloSCT to diagnosis of 2 years. Joint involvement was significant, affecting over half the cohort. Among those assessed (81 patients), 41% had an ECOG score of ≥2, indicating impaired performance status. Of the patients, 51% underwent joint replacement surgery, predominantly involving hip replacements (62%). Post-surgery, 40% achieved full mobility. Three months after surgery, opioid use decreased to 67%, while 62% of patients with available ECOG scores had improved to scores of 0-1 (Table 2). The overall mortality rate was 19%, with infections and disease relapse as the leading causes. Notably, there were no deaths within three months post-surgery. Conclusion This study provides crucial insights into the management of AVN in adult alloSCT recipients, highlighting the high morbidity, opioid dependency , and improved outcomes associated with joint replacement surgery. Despite ongoing GVHD, surgical intervention was safe and resulted in no mortality within the initial postoperative period . Thus, joint replacement should be considered a viable treatment option for alloSCT patients with AVN.
Authors: Dania Shoaib, Aroog Khaliq, William Wesson, Maggie Ziegler, Emerson Logan, Carine Tabak, Emily Casteen, Sarah Fitzmaurice, Cherie Morey, Rajat Bansal, Muhammad Umair Mushtaq, Haitham Abdelhakim, Leyla Shune, Forat Lutfi, Mr. Shaun DeJarnette, Al-Ola Abdallah, Anthony D Sung, Anurag K. Singh, Sunil H. Abhyankar, Joseph P McGuirk, Christian Timothy Sinclair, Nausheen Ahmed
Language: English
Topic: Bone and Joint Diseases
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W4407977149