Prevalence of osteonecrosis and associated risk factors in children before allogeneic BMT

• Published in: Bone marrow transplantation (Basingstoke) Vol. 46; no. 6; pp. 813 - 819
• Main Authors: Sharma, S, Yang, S, Rochester, R, Britton, L, Leung, W-H, Yang, J, Neel, M D, Ness, K K, Kaste, S C
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2011; Nature Publishing Group
• Subjects: 631/250/1904; 692/499; 692/699/1670; 692/700/1720; Adolescent; Age Factors; Anemia; Anemia, Aplastic - therapy; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aplastic anemia; Biological and medical sciences; Biomedical materials; Bone marrow; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Bones; Cell Biology; Child; Child, Preschool; Children; Diseases of the osteoarticular system; Factor analysis; Female; Health aspects; Hematology; Hip; Humans; Infant; Internal Medicine; Knee; Leukemia, Lymphoid - therapy; Magnetic resonance; Magnetic Resonance Imaging; Male; Medical sciences; Medical treatment; Medicine; Medicine & Public Health; Necrosis; original-article; Osteonecrosis; Osteonecrosis - epidemiology; Patients; Prevalence; Public Health; Retrospective Studies; Risk analysis; Risk Factors; Sex Factors; Signs and symptoms; Stem cell transplantation; Stem Cells; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Vascular bone diseases; Young Adult; United States; aplastic anemia; osteonecrosis; allogeneic BMT; children; lymphphoid malignancies; Human; Prevalence; Hematology; Allogeneic bone marrow transplantation; Stem cell; Diseases of the osteoarticular system; Aplastic anemia; Hematopoietic cell; Homograft; Hemopathy; Malignancy; Osteonecrosis; Malignant tumor; Epidemiology; Bone marrow failure; Risk factor; Bone marrow; Graft; Child; Cancer
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2010.210

Osteonecrosis (ON) is a debilitating long-term complication of allogeneic BMT (allo-BMT), but may begin before allo-BMT in some children because of their primary disease treatment. Therefore, to estimate the prevalence and associated risk factors for ON before allo-BMT, we conducted a retrospective analysis of magnetic resonance (MR) studies of 118 children who underwent first allo-BMT at our institution between December 2000 and September 2007. Of the 118 consecutive patients, 107 (90.7%) underwent prospective MR studies irrespective of symptoms (69 males; median age at allo-BMT 12.9 years), and 11 underwent MR studies for symptoms. Among the 107 who had prospective imaging, 23 (21.5%) had ON; nearly 50% had at least 30% epiphyseal involvement. Knees were more frequently involved than were hips; severity of ON was greater in hips. ON prevalence before allo-BMT was 23.72% when all 118 patients were included in the denominator. Risk factor analysis, limited to MR studies performed irrespective of symptoms, revealed female gender ( P =0.049) and age ⩾10 years at the time of MR study ( P =0.03) as significant risk factors, and primary diagnosis of lymphoid malignancies and aplastic anemia trended toward significance. ON before allo-BMT is a common occurrence in children.