Avascular osteonecrosis after allogeneic hematopoietic stem-cell transplantation: Diagnosis and gender matter
Avascular osteonecrosis after allogeneic hematopoietic stem-cell transplantation: Diagnosis and gender matter
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DOI：
10.1097/01.tp.0000138026.40907.38
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发表时间：
2004-10-15
期刊：
影响因子：
6.2
通讯作者：
Beelen, DW
中科院分区：
文献类型：
--
作者：
Schulte, CMS;Beelen, DW
背景缺血性骨坏死（AVN）是异基因造血干细胞移植（SCT）的严重并发症。急性和慢性移植物抗宿主病及其类固醇治疗被确定为主要危险因素。在一项单中心、前瞻性队列研究中，我们对接受同种异体SCT治疗慢性髓细胞白血病（CML）、急性髓细胞白血病、骨髓增生异常综合征和急性淋巴细胞白血病的患者进行了研究，确定了需要全关节置换术的髋关节AVN的发生率（严重不良事件），并进行了危险因素分析。共对255例患者进行了至少4年的随访观察。采用单因素和多因素名义Logistic和考克斯比例风险分析对年龄、受者和供者性别、基础疾病和疾病分期、预处理治疗、人类白细胞抗原匹配、急性或慢性移植物抗宿主病和免疫抑制剂治疗等13个潜在风险因素进行了检验。8例患者发生严重不良事件（4年累积发生率6.1%）。单因素和多因素分析显示，CML以外的诊断和类固醇摄入是主要的危险因素（卡方（2）模型31.6，P = 0.0005;卡方（2）诊断11，P = 0.001;卡方（2）类固醇6.8，P = 0.009）。诊断的明显强烈影响是不依赖于类固醇的（CML中的类固醇摄入与非CML相当）。我们对103例非CML患者（70例急性髓细胞白血病，13例骨髓增生异常综合征，20例急性淋巴细胞白血病）进行了重复分析，排除了152例CML患者。单因素和多因素分析显示，女性（受体和供体）是AVN的危险因素，除了类固醇。女性与男性供体移植的相对AVN风险为8.7（P = 0.01），女性与男性受体移植的相对AVN风险为4.3（P = 0.047）。诊断和性别是异基因SCT后严重髋关节AVN的非激素依赖性危险因素。
Background. Avascular osteonecrosis (AVN) is a serious complication of allogeneic stem-cell transplantation (SCT). Acute and chronic graft-versus-host disease and its treatment with steroids are identified as main risk factors. In a single-center, prospective cohort study of patients undergoing allogeneic SCT for chronic myeloid leukemia (CML), acute myeloid leukemia, myelodysplastic syndrome, and acute lymphatic leukemia, we determined the incidence of hip AVN necessitating total arthroplasty (severe adverse event) and performed risk factor analysis.Methods. A total of 255 patients were followed for an observation period of at least 4 years. Thirteen potential risk factors including age, recipient and donor gender, underlying disease and disease stage, conditioning therapy, human leukocyte antigen match, acute or chronic graft-versus-host disease, and immunosuppressive medication were tested in univariate and multifactorial nominal logistic and Cox proportional hazard analyses.Results. Severe adverse events occurred in eight patients (4-year cumulative incidence rate 6.1%). Univariate and multifactorial analysis revealed a diagnosis other than CML and steroid intake as main risk factors (chi(2) model 31.6, P = 0.0005; chi(2) diagnosis 11, P = 0.001; chi(2) steroid 6.8, P = 0.009). The demonstrably strong influence of diagnosis was steroid independent (steroid intake in CML comparable to non-CML). We repeated the analysis in 103 patients without CML (70 with acute myeloid leukemia, 13 with myelodysplastic syndrome, and 20 with acute lymphatic leukemia), excluding 152 patients with CML. Univariate and multifactorial analyses revealed female gender (of both recipient and donor) as risk factors for AVN in addition to steroids. Relative AVN risk for female compared with male donor transplantation was 8.7 (P = 0.01); relative AVN risk for female compared with male recipient transplantation was 4.3 (P = 0.047).Conclusions. Diagnosis and gender are steroid-independent risk factors for severe hip AVN after allogeneic SCT.