Bone Mineral Turnover after Allogeneic Hematopoietic Stem Cell Transplantation in Children: A Single Center Cohort Study

• Main Authors: Yuliya V. Skvortsova, Dmitriy N. Balashov, Elena V. Skorobogatova, Zhanna B. Shekhovtsova, Kirill A. Voronin, Alexei A. Maschan
• Format: Article
• Language: English
• Published: Paediatrician Publishers, LLC 2018-01-01
• Series: Pediatričeskaâ Farmakologiâ
• Subjects: allogeneic transplantation; hematopoietic stem cell; late effects; osteopenia; osteoporosis; avascular necrosis
• Online Access: https://www.pedpharma.ru/jour/article/view/1575

Bone mineral metabolism disorders are one of the most frequent late complications after allogeneic hematopoietic stem cell transplantation (HSCT) in children.The aim of the study was to detect the incidence and risk factors for bone mineral metabolism disorders in children who underwent allogeneic HSCT.Methods. We analyzed the data of medical charts of 294 children aged 0–17 y.o. who were hospitalized in 1994–2011, received  allogeneic HSCT, and survived for at least a year after intervention.  We determined the cumulative incidence and revealed risk factors for the development of osteopenia/osteoporosis and avascular necrosis.  Osteopenia/ osteoporosis was diagnosed after X-ray examination and annual computer X-ray osteodensitometry of the lumbar spine (during a 5-year period since 2003). The criteria for osteopenia is  bone density z-score 2.0, for osteoporosis — z-score 2.0 and  suffered fractures of the bones of the legs, compression fractures of  the spine and / or 2 fractures of the tubular bones of the hands (for both diagnoses). Avascular necrosis was diagnosed  radiographically and basing on magnetic resonance imaging results  (if there were complaints of pain or limb dysfunctions).Results. After the allogeneic HSCT during the median follow-up of 7.5 years bone mineral metabolism disorders developed in 48  patient (16%). Osteopenia / osteoporosis development was  associated with the following factors: the age 10 years (frequency  23.2% vs. 12% in children under 10 years, p = 0.014), acute graft- versus-host disease (GVHD) grade II–IV (24.2 vs 8.7% at GVHD  grade 0–I; p = 0.001), chronic GVHD (36.0% in extensive form vs.  14.5% in restricted form and 8.4% in the absence of chronic GVHD; p<0.001), immunosuppressive therapy >12 months (31.9 vs. 6.9% for therapy <3 months; p<0.001), glucocorticosteroid intake >3  months (93.8 vs 8.1% with GCs administration 3 months and 3.2% without GCs administration; p<0.001).Conclusion. Bone mineral metabolism disorders are revealed in 16% of cases in children who underwent HSCT. Determination of risk factors provides the possibility for timely diagnostics and improvement of therapy results.