AVASCULAR NECROSIS OF BONE IN ADULT PATIENTS SURVIVING MORE THAN 2 YEARS AFTER ALLOGENEIC STEM CELL TRANSPLANTATION IN YEARS 2001-2012 - EXPERIENCE OF SLOVAK TRANSPLANTATION CENTRE
(Abstract release date: 05/19/16)
EHA Library. Martišová M. 06/09/16; 135063; PB2163
Dr. Michaela Martišová
Contributions
Contributions
Abstract
Abstract: PB2163
Type: Publication Only
Background
Avascular necrosis (AVN) of bone is the most debilitating late skeletal complication of stem cell transplantation (SCT) that often remains underestimated.
Aims
To evaluate potential risk factors of AVN, its clinical manifestation and treatment in patients after SCT.
Methods
One hundred thirty-five patients surviving more than 24 months after allogeneic SCT in years 2001-2012 in Slovak Transplantation Centre were evaluated retrospectively for AVN. All patients were disease-free after SCT for malignant and non-malignant hematological diseases. AVN was confirmed by magnetic resonance imaging or scintigraphy. We investigated correlations between AVN and primary diagnosis (malignant/non-malignant), conditioning regimens, donor and patient gender, type of donor (related/unrelated), HLA match, AB0 compatibility, source of stem cells (peripheral/bone marrow), immunosuppressive therapy, GvHD (acute/chronic), exposure time and cumulative dose of corticosteroids. We analysed time to first symptoms, time to diagnosis of AVN, number of joints, most affected sites, correlation between joint pain and imaging exams, types of treatment and their results.
Results
Seven patients surviving 30-169 months (median, 69 months) after SCT developed AVN (5.2%). We experienced more AVN in male patients (83%), but found no correlation with other factors. Cumulative dose of corticosteroids was 0-5264mg (median, 3960mg) and exposure time was 0-327 days (median, 53days). Patients developed arthralgias 9-56 months (median, 28 months) after SCT. AVN was confirmed 1-17 months (median, 6 months) after onset of the symptoms and 14-62 months (median, 36 months) after SCT. We confirmed AVN of 19 joints (2.71 joints per patient) – hip (12), shoulder (5) and sacroiliacal joints (2). We recognized higher incidence of AVN in patients who suffered from AVN of at least one joint, although the other affected joints weren't always marked as painful (hip: 8 painful joints in correlation with 12 joints with proved AVN in 6 patients; shoulder: 4 painful joints in correlation with 5 joints with proved AVN in 3 patients). We confirmed bilateral occurrence of AVN of hip joints regardless of the number of painful hip joints. Because of lack of MRI of painful knees we weren't able to evaluate the rate of AVN although knees were the second most painful joints. AVN of sacroiliacal joints was asymptomatic.Conservative treatment was performed in shoulder joints, surgical treatment was performed just in hip joints - 4 of 6 patients underwent total hip replacement (THR) of 6 joints. Age median of patients undergoing THR was 26 years. One patient in an early stage of AVN underwent forrage and 1 patient was on conservative treatment while waiting for THR. Out of 6 THRs we experienced no septic or aseptic loosening in an early post-operative period. We followed the patients after THR for 11-143 months (median, 30 months). Out of 6 replaced hip joints we experienced deliberation of acetabular and distal femoral component in 1 patient, 8 years after implantation. Reimplantation was performed without any complications.
Conclusion
Avascular necrosis occurred more in male patients in our study. We didn't define any other risk factor for AVN. We observed the highest incidence of AVN of hip joints with 100% bilateral occurrence, where imaging exams were more sensitive than corresponding clinical symtomatology. Surgical methods of AVN treatment remain to be gold standard for higher stages of AVN of hip joints with favorable benefit-risk ratio.
Session topic: E-poster
Type: Publication Only
Background
Avascular necrosis (AVN) of bone is the most debilitating late skeletal complication of stem cell transplantation (SCT) that often remains underestimated.
Aims
To evaluate potential risk factors of AVN, its clinical manifestation and treatment in patients after SCT.
Methods
One hundred thirty-five patients surviving more than 24 months after allogeneic SCT in years 2001-2012 in Slovak Transplantation Centre were evaluated retrospectively for AVN. All patients were disease-free after SCT for malignant and non-malignant hematological diseases. AVN was confirmed by magnetic resonance imaging or scintigraphy. We investigated correlations between AVN and primary diagnosis (malignant/non-malignant), conditioning regimens, donor and patient gender, type of donor (related/unrelated), HLA match, AB0 compatibility, source of stem cells (peripheral/bone marrow), immunosuppressive therapy, GvHD (acute/chronic), exposure time and cumulative dose of corticosteroids. We analysed time to first symptoms, time to diagnosis of AVN, number of joints, most affected sites, correlation between joint pain and imaging exams, types of treatment and their results.
Results
Seven patients surviving 30-169 months (median, 69 months) after SCT developed AVN (5.2%). We experienced more AVN in male patients (83%), but found no correlation with other factors. Cumulative dose of corticosteroids was 0-5264mg (median, 3960mg) and exposure time was 0-327 days (median, 53days). Patients developed arthralgias 9-56 months (median, 28 months) after SCT. AVN was confirmed 1-17 months (median, 6 months) after onset of the symptoms and 14-62 months (median, 36 months) after SCT. We confirmed AVN of 19 joints (2.71 joints per patient) – hip (12), shoulder (5) and sacroiliacal joints (2). We recognized higher incidence of AVN in patients who suffered from AVN of at least one joint, although the other affected joints weren't always marked as painful (hip: 8 painful joints in correlation with 12 joints with proved AVN in 6 patients; shoulder: 4 painful joints in correlation with 5 joints with proved AVN in 3 patients). We confirmed bilateral occurrence of AVN of hip joints regardless of the number of painful hip joints. Because of lack of MRI of painful knees we weren't able to evaluate the rate of AVN although knees were the second most painful joints. AVN of sacroiliacal joints was asymptomatic.Conservative treatment was performed in shoulder joints, surgical treatment was performed just in hip joints - 4 of 6 patients underwent total hip replacement (THR) of 6 joints. Age median of patients undergoing THR was 26 years. One patient in an early stage of AVN underwent forrage and 1 patient was on conservative treatment while waiting for THR. Out of 6 THRs we experienced no septic or aseptic loosening in an early post-operative period. We followed the patients after THR for 11-143 months (median, 30 months). Out of 6 replaced hip joints we experienced deliberation of acetabular and distal femoral component in 1 patient, 8 years after implantation. Reimplantation was performed without any complications.
Conclusion
Avascular necrosis occurred more in male patients in our study. We didn't define any other risk factor for AVN. We observed the highest incidence of AVN of hip joints with 100% bilateral occurrence, where imaging exams were more sensitive than corresponding clinical symtomatology. Surgical methods of AVN treatment remain to be gold standard for higher stages of AVN of hip joints with favorable benefit-risk ratio.
Session topic: E-poster
Abstract: PB2163
Type: Publication Only
Background
Avascular necrosis (AVN) of bone is the most debilitating late skeletal complication of stem cell transplantation (SCT) that often remains underestimated.
Aims
To evaluate potential risk factors of AVN, its clinical manifestation and treatment in patients after SCT.
Methods
One hundred thirty-five patients surviving more than 24 months after allogeneic SCT in years 2001-2012 in Slovak Transplantation Centre were evaluated retrospectively for AVN. All patients were disease-free after SCT for malignant and non-malignant hematological diseases. AVN was confirmed by magnetic resonance imaging or scintigraphy. We investigated correlations between AVN and primary diagnosis (malignant/non-malignant), conditioning regimens, donor and patient gender, type of donor (related/unrelated), HLA match, AB0 compatibility, source of stem cells (peripheral/bone marrow), immunosuppressive therapy, GvHD (acute/chronic), exposure time and cumulative dose of corticosteroids. We analysed time to first symptoms, time to diagnosis of AVN, number of joints, most affected sites, correlation between joint pain and imaging exams, types of treatment and their results.
Results
Seven patients surviving 30-169 months (median, 69 months) after SCT developed AVN (5.2%). We experienced more AVN in male patients (83%), but found no correlation with other factors. Cumulative dose of corticosteroids was 0-5264mg (median, 3960mg) and exposure time was 0-327 days (median, 53days). Patients developed arthralgias 9-56 months (median, 28 months) after SCT. AVN was confirmed 1-17 months (median, 6 months) after onset of the symptoms and 14-62 months (median, 36 months) after SCT. We confirmed AVN of 19 joints (2.71 joints per patient) – hip (12), shoulder (5) and sacroiliacal joints (2). We recognized higher incidence of AVN in patients who suffered from AVN of at least one joint, although the other affected joints weren't always marked as painful (hip: 8 painful joints in correlation with 12 joints with proved AVN in 6 patients; shoulder: 4 painful joints in correlation with 5 joints with proved AVN in 3 patients). We confirmed bilateral occurrence of AVN of hip joints regardless of the number of painful hip joints. Because of lack of MRI of painful knees we weren't able to evaluate the rate of AVN although knees were the second most painful joints. AVN of sacroiliacal joints was asymptomatic.Conservative treatment was performed in shoulder joints, surgical treatment was performed just in hip joints - 4 of 6 patients underwent total hip replacement (THR) of 6 joints. Age median of patients undergoing THR was 26 years. One patient in an early stage of AVN underwent forrage and 1 patient was on conservative treatment while waiting for THR. Out of 6 THRs we experienced no septic or aseptic loosening in an early post-operative period. We followed the patients after THR for 11-143 months (median, 30 months). Out of 6 replaced hip joints we experienced deliberation of acetabular and distal femoral component in 1 patient, 8 years after implantation. Reimplantation was performed without any complications.
Conclusion
Avascular necrosis occurred more in male patients in our study. We didn't define any other risk factor for AVN. We observed the highest incidence of AVN of hip joints with 100% bilateral occurrence, where imaging exams were more sensitive than corresponding clinical symtomatology. Surgical methods of AVN treatment remain to be gold standard for higher stages of AVN of hip joints with favorable benefit-risk ratio.
Session topic: E-poster
Type: Publication Only
Background
Avascular necrosis (AVN) of bone is the most debilitating late skeletal complication of stem cell transplantation (SCT) that often remains underestimated.
Aims
To evaluate potential risk factors of AVN, its clinical manifestation and treatment in patients after SCT.
Methods
One hundred thirty-five patients surviving more than 24 months after allogeneic SCT in years 2001-2012 in Slovak Transplantation Centre were evaluated retrospectively for AVN. All patients were disease-free after SCT for malignant and non-malignant hematological diseases. AVN was confirmed by magnetic resonance imaging or scintigraphy. We investigated correlations between AVN and primary diagnosis (malignant/non-malignant), conditioning regimens, donor and patient gender, type of donor (related/unrelated), HLA match, AB0 compatibility, source of stem cells (peripheral/bone marrow), immunosuppressive therapy, GvHD (acute/chronic), exposure time and cumulative dose of corticosteroids. We analysed time to first symptoms, time to diagnosis of AVN, number of joints, most affected sites, correlation between joint pain and imaging exams, types of treatment and their results.
Results
Seven patients surviving 30-169 months (median, 69 months) after SCT developed AVN (5.2%). We experienced more AVN in male patients (83%), but found no correlation with other factors. Cumulative dose of corticosteroids was 0-5264mg (median, 3960mg) and exposure time was 0-327 days (median, 53days). Patients developed arthralgias 9-56 months (median, 28 months) after SCT. AVN was confirmed 1-17 months (median, 6 months) after onset of the symptoms and 14-62 months (median, 36 months) after SCT. We confirmed AVN of 19 joints (2.71 joints per patient) – hip (12), shoulder (5) and sacroiliacal joints (2). We recognized higher incidence of AVN in patients who suffered from AVN of at least one joint, although the other affected joints weren't always marked as painful (hip: 8 painful joints in correlation with 12 joints with proved AVN in 6 patients; shoulder: 4 painful joints in correlation with 5 joints with proved AVN in 3 patients). We confirmed bilateral occurrence of AVN of hip joints regardless of the number of painful hip joints. Because of lack of MRI of painful knees we weren't able to evaluate the rate of AVN although knees were the second most painful joints. AVN of sacroiliacal joints was asymptomatic.Conservative treatment was performed in shoulder joints, surgical treatment was performed just in hip joints - 4 of 6 patients underwent total hip replacement (THR) of 6 joints. Age median of patients undergoing THR was 26 years. One patient in an early stage of AVN underwent forrage and 1 patient was on conservative treatment while waiting for THR. Out of 6 THRs we experienced no septic or aseptic loosening in an early post-operative period. We followed the patients after THR for 11-143 months (median, 30 months). Out of 6 replaced hip joints we experienced deliberation of acetabular and distal femoral component in 1 patient, 8 years after implantation. Reimplantation was performed without any complications.
Conclusion
Avascular necrosis occurred more in male patients in our study. We didn't define any other risk factor for AVN. We observed the highest incidence of AVN of hip joints with 100% bilateral occurrence, where imaging exams were more sensitive than corresponding clinical symtomatology. Surgical methods of AVN treatment remain to be gold standard for higher stages of AVN of hip joints with favorable benefit-risk ratio.
Session topic: E-poster
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