Bone Health Management After Hematopoietic Cell Transplantation: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy
Bone Health Management After Hematopoietic Cell Transplantation: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy
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DOI：
10.1016/j.bbmt.2020.07.001
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发表时间：
2020-10-01
影响因子：
4.3
通讯作者：
Carpenter, Paul A.
中科院分区：
文献类型：
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作者：
Bar, Merav;Ott, Susan M.;Carpenter, Paul A.
造血细胞移植(HCT)后常出现骨健康障碍，主要表现为骨密度丢失(BMD)和缺血性坏死(AVN)。BMD丢失与移植前化疗和放射暴露以及移植物抗宿主病(GVHD)的免疫抑制治疗有关，也与生长或性腺激素不足、钙和维生素D稳态失调以及成骨细胞和破骨细胞功能障碍有关。尽管AVN的病理生理学机制尚不清楚，但最常见的关联是大剂量糖皮质激素暴露。关于骨质疏松症的社会治疗指南有多种，但主要集中在与绝经相关的骨质疏松症。HCT幸存者包括一个独特的并存人群，这使得一般的骨骼健康管理方法在某些情况下是不合适的。为了回答与HCT骨健康相关的16个核心常见问题(FAQ)，美国移植和细胞治疗委员会实践指南委员会召集了一个由HCT、成人和儿童内分泌学、骨科和口腔医学专家组成的小组。由于缺乏专门针对HCT患者骨健康的相关前瞻性对照临床试验，常见问题的答案依赖于来自回顾HCT研究的证据、非HCT环境下的前瞻性研究的推断结果、相关的社会指南和专家小组的意见。考虑到接受HCT的个体的异质性合并症和需求，本文中常见问题的回答应被视为一般性建议，良好的医疗实践和判断最终决定了对个体患者的护理。读者可以参考补充材料，以获得没有构成核心集的其他常见问题的答案。(C)2020年美国移植和细胞治疗学会。由爱思唯尔公司出版。
Bone health disturbances commonly occur after hematopoietic cell transplantation (HCT) with loss of bone mineral density (BMD) and avascular necrosis (AVN) foremost among them. BMD loss is related to pretransplantation chemotherapy and radiation exposure and immunosuppressive therapy for graft-versus-host-disease (GVHD) and results from deficiencies in growth or gonadal hormones, disturbances in calcium and vitamin D homeostasis, as well as osteoblast and osteoclast dysfunction. Although the pathophysiology of AVN remains unclear, highdose glucocorticoid exposure is the most frequent association. Various societal treatment guidelines for osteoporosis exist, but the focus is mainly on menopausal-associated osteoporosis. HCT survivors comprise a distinct population with unique comorbidities, making general approaches to bone health management inappropriate in some cases. To address a core set of 16 frequently asked questions (FAQs) relevant to bone health in HCT, the American Society of Transplant and Cellular Therapy Committee on Practice Guidelines convened a panel of experts in HCT, adult and pediatric endocrinology, orthopedics, and oral medicine. Owing to a lack of relevant prospective controlled clinical trials that specifically address bone health in HCT, the answers to the FAQs rely on evidence derived from retrospective HCT studies, results extrapolated from prospective studies in non-HCT settings, relevant societal guidelines, and expert panel opinion. Given the heterogenous comorbidities and needs of individual HCT recipients, answers to FAQs in this article should be considered general recommendations, with good medical practice and judgment ultimately dictating care of individual patients. Readers are referred to the Supplementary Material for answers to additional FAQs that did not make the core set. (c) 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.