Bone density loss after allogeneic hematopoietic stem cell transplantation: A prospective study
Bone density loss after allogeneic hematopoietic stem cell transplantation: A prospective study
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DOI：
10.1053/bbmt.2001.v7.pm11400947
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发表时间：
2001-01-01
影响因子：
4.3
通讯作者：
Sherrard, DF
中科院分区：
文献类型：
--
作者：
Stern, JM;Sullivan, KM;Sherrard, DF
造血干细胞移植后骨密度异常的发生率和病程尚不清楚，且受多种因素的影响。在同种异体移植后3个月和12个月，测量了104名成人（54名女性，54名男性;平均年龄40岁[范围，18-64岁]）的髋关节、脊柱和腕关节骨密度（BMD）。采用单变量和多变量分析评价临床和实验室变量，以确定骨质疏松、骨折和缺血性坏死的危险因素。在移植后3个月，合并（男性和女性）髋关节、脊柱和腕关节z评分分别为-0.35、-0.42和+0.04标准差。在12个月时，男性和女性的髋部BMD均显著下降（4.2%，P <0.0001）;脊柱和手腕的变化很小。糖皮质激素治疗的累积剂量和天数以及环孢霉素或他克莫司治疗的天数与BMD的损失显着相关;年龄，全身照射，诊断和供体类型没有。移植后3年内，10.6%的患者发生非创伤性骨折，9.6%的患者发生缺血性坏死。移植前和移植后12个月之间的身高下降是显著的（P = .0001）。结果表明，同种异体干细胞移植后骨密度的损失是常见的，并加速免疫抑制治疗的时间和糖皮质激素的累积剂量。骨折和缺血性坏死的发生率增加可能对长期生活质量产生不利影响。干细胞移植后骨脱矿的预防似乎是必要的。
The incidence and course of bone density abnormalities following hematopoietic stem cell transplantation are poorly understood and complicated by the impact of multiple factors. Hip, spine, and wrist bone mineral densities (BMDs) were measured in 104 adults (54 women, 54 men; mean age, 40 years [range, 18-64 years]) at 3 and 12 months after allogeneic transplantation. Clinical and laboratory variables were evaluated using univariate and multivariate analyses to determine risk factors for osteoporosis, fracture, and avascular necrosis. At 3 months posttransplantation, combined (male and female) hip, spine, and wrist z scores were -0.35, -0.42, and +0.04 standard deviations, respectively. At 12 months both men and women experienced significant loss of hip BMD (4.2%, P < .0001); changes in the spine and wrist were minimal. The cumulative dose and number of days of glucocorticoid therapy and the number of days of cyclosporine or tacrolimus therapy showed significant associations with loss of BMD; age, total body irradiation, diagnosis, and donor type did not. Nontraumatic fractures occurred in 10.6% of patients and avascular necrosis in 9.6% within 3 years posttransplantation. The decrease in height between pretransplantation and 12 months posttransplantation was significant (P = .0001). Results indicate that loss of BMD after allogeneic stem cell transplantation is common and accelerated by the length of immunosuppressive therapy and cumulative dose of glucocorticoid. An increased incidence of fracture and avascular necrosis may adversely impact long-term quality of life. Prevention of bone demineralization appears warranted after stem cell transplantation.