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15-01-2012 | General practice | Article

Long-term follow-up links alloHSCT with bone deficits


Free abstract

MedWire News: Children treated with allogeneic hematopoietic stem cells have significant bone mass and structure deficits in the years following transplantation, US research shows.

Seven years after treatment with the stem cells, trabecular and cortical bone mineral density (BMD), and cortical geometry, were significantly impaired in the patients compared with healthy children, report researchers.

"The magnitude of these deficits exceeded those observed in children with active Crohn's disease, juvenile rheumatoid arthritis, and chronic kidney disease," say Sogol Mostoufi-Moab (The Children's Hospital of Philadelphia, Pennsylvania) and colleagues in the Journal of Bone and Mineral Research.

Allogeneic hematopoietic stem-cell transplantation (alloHSCT) is an effective treatment for hematologic malignancies in children and adults, but alloHSCT recipients are at risk for poor bone health.

The reasons for impaired bone health include malnutrition, vitamin D deficiency, hormonal deficiencies, and use of immunosuppressive drugs. Dual X-ray absorptiometry (DXA) studies have shown significant bone deficits in adults and children in the first year following alloHSCT.

To assess the long-term effects of alloHSCT, Mostoufi-Moab and colleagues studied 55 children and young adults, aged 5 to 26 years old, who received stem cells for treatment of leukemia or bone marrow failure syndrome.

In a median follow-up of 7 years, alloHSCT recipients had significantly lower trabecular volumetric BMD compared with more than 700 healthy controls, whereas cortical BMD Z-scores did not differ.

Cortical Zp, a summary measure of cortical bone strength and structure, was significantly lower in the alloHSCT recipients than the controls. The cortical cross-sectional area (CSA) was also significantly lower in the patients than controls.

The results highlight "the lasting impact of alloHSCT and its therapies," report Mostoufi-Moab and colleagues.

The stem-cell recipients had higher fat CSA and lower muscle CSA Z-scores compared with controls, findings that the researchers say are in line with the DXA results.

They add that further studies are needed to determine if the deficits progress or recover in later adolescence and early adulthood. Longitudinal studies are also needed to determine if these deficits are correlated with fractures.

By MedWire Reporters

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