Predictors of avascular necrosis of bone in long-term survivors of hematopoietic cell transplantation.
Predictors of avascular necrosis of bone in long-term survivors of hematopoietic cell transplantation.
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DOI：
10.1002/cncr.24474
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发表时间：
2009-09-15
期刊：
影响因子：
6.2
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
--
作者：
Campbell, Stephanie;Sun, Can-Lan;Kurian, Seira;Francisco, Liton;Carter, Andrea;Kulkarni, Sameer;Parker, Pablo;Karanes, Chatchada;Forman, Stephen J.;Bhatia, Smita
关键词：
缺血性坏死（AVN）是一种慢性类固醇使用后报告的衰弱性疾病。本研究的目的是描述造血细胞移植（HCT）后存活一年或一年以上的个体的风险程度，并研究免疫抑制剂如泼尼松、他克莫司（FK 506）、霉酚酸酯（MMF）和环孢素（CSA）在HCT后AVN发生中的作用。采用回顾性研究设计，我们随访了1，346例符合条件的AVN患者。计算累积发生率时考虑了死亡和复发的竞争风险。考克斯比例回归技术用于确定相关的危险因素。HCT时的中位年龄为34岁（范围：7个月-69岁），存活患者的中位随访时间为8.2年。75例患者发生160个关节的AVN。10年时AVN的累积发生率在自体HCT后为2.9%，在同种异体匹配的相关供体HCT后为5.4%，在无关供体HCT后为15%（与自体HCT受体相比p<0.001）。对于同种异体移植受者，男性（RR=2.1，95%CI，1.1-4.0）、存在慢性GvHD（RR=2.2）和暴露于CSA、FK 506、泼尼松和MMF使患者的风险增加，尤其是有3种或3种以上药物暴露史的患者（RR=9.2，95%CI，2.42-35.24）。未来的研究检查AVN的发病机制，应有助于制定有针对性的干预措施，以防止这种慢性衰弱的条件。
Avascular necrosis (AVN) is a debilitating condition reported after chronic steroid use. The purpose of this study was to describe the magnitude of risk in individuals who survived one or more years after hematopoietic cell transplantation (HCT), and to investigate the role of immunosuppressive agents such as prednisone, tacrolimus (FK506), mycophenolate mofetil (MMF), and cyclosporine (CSA) in the development of AVN after HCT. Using a retrospective study design, we followed 1,346 eligible patients for the development of AVN. Cumulative incidence was calculated taking into consideration competing risk from death and relapse. Cox proportional regression techniques were used to identify associated risk factors. The median age at HCT was 34 years (range, 7 months–69 years), and median length of follow-up for those alive was 8.2 years. Seventy-five patients developed AVN of 160 joints. The cumulative incidence of AVN at 10 years was 2.9% after autologous HCT, 5.4% after allogeneic matched related donor HCT, and 15% after unrelated donor HCT (p<0.001 compared to autologous HCT recipients). For allogeneic transplant recipients, male sex (RR=2.1, 95% CI, 1.1–4.0), presence of chronic GvHD (RR=2.2) and exposure to CSA, FK506, prednisone and MMF rendered patients at increased risk, especially in patients with a history of exposure to three or more drugs (RR=9.2, 95%CI, 2.42–35.24). Future studies examining the pathogenetic mechanism underlying AVN should help develop targeted interventions to prevent this chronic debilitating condition.
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影响因子：
6.2
作者：
Schulte, CMS;Beelen, DW
通讯作者：
Beelen, DW
DOI：
10.1302/0301-620x.59b3.893509
发表时间：
1977-01-01
影响因子：
--
作者：
CRUESS, RL
通讯作者：
CRUESS, RL
影响因子：
45.3
作者：
Strauss, AJ;Su, JT;Silverman, LB
通讯作者：
Silverman, LB
DOI：
10.1053/bbmt.2001.v7.pm11400947
发表时间：
2001-01-01
影响因子：
4.3
作者：
Stern, JM;Sullivan, KM;Sherrard, DF
通讯作者：
Sherrard, DF
影响因子：
6.2
作者：
Abbott, KC;Koff, J;Schnitzler, MA
通讯作者：
Schnitzler, MA