scholarly journals Bone Complications in Allogenic Hematopoietic Stem Cell Transplantation

2019 ◽  
pp. 260-272
Author(s):  
Saowapa S ◽  
Isenberg JS ◽  
Salehian B
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Bone Loss ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem ◽  
Total Body ◽  
Secondary Hypogonadism ◽  
Bone Complications

Allogenic hematopoietic stem cell transplantation (allogenic HSCT) is employed to treat benign and malignanthematologic disorders. Increased use of allogenic HSCT has improved outcomes and patient survival, but has led to increased complications. Bone complications following HSCT include osteopenia, osteoporosis, avascular necrosis (AVN) and fracture. These complications decrease patient quality of life and increase morbidity. Allogenic HSCTassociated bone loss is linked to multiple factors including pre-transplant physiologic risk, myeloablative regimens, total-body irradiation, graft-versus-host disease (GVHD), immunosuppressive regimens, secondary hypogonadism, intestinal malabsorption and renal dysfunction. However, the precise molecular causes of HSCT-associated bone loss remain to be determined. Herein, we summarize the epidemiology, risk factors, and pathophysiology of allogenic HSCT-related bone loss and fracture. Also, review is made of the current modalities for prevention and treatment of these complications.

Bone loss following hematopoietic stem cell transplantation: a long-term follow-up

Blood ◽  
2004 ◽  
Vol 103 (10) ◽  
pp. 3635-3643 ◽  
Author(s):  
Claudia M. S. Schulte ◽  
Dietrich W. Beelen
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Bone Loss ◽  
Femoral Neck ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem ◽  
Total Body

Abstract Transplantation-associated bone loss is a well-known phenomenon, however, effects of hematopoietic stem cell transplantation are insufficiently characterized. We conducted a prospective, unicentric, long-term follow-up in 280 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Bone mineral density (BMD) was measured before transplantation and then yearly for at least 4 years. Patients received vitamin D plus calcium until steroid withdrawal. Mean baseline BMD was normal. We demonstrated significant bone loss with nadir BMD at month 6 for the spine and at month 24 for total body and femoral neck. Average annual bone loss was 0.6% for spine, 0.4% for total body, 2.3% for femoral neck, and 3.5% for Ward triangle. While spine and total body BMD returned to baseline, bone loss at femoral neck sites was attenuated, but BMD did not return to baseline until month 48 (P < .0001 for femoral neck and Ward triangle). Univariate factor analysis of 15 potential risk factors for rapid bone loss revealed a positive correlation of bone loss with steroid and cyclosporine A use, baseline BMD, and loss of muscle mass (overwhelming power of steroid use in multifactor analysis). Such rapid BMD changes probably increase fracture risk consecutive to irreversible microarchitectural changes even if osteodensitometry shows long-term recovery.

Radiation-induced kidney injury

2019 ◽  
Vol 3 (3) ◽  
pp. 160-167 ◽  
Author(s):  
Jaya Kala
Keyword(s):  
Experimental Data ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Radiation Exposure ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Total Body Irradiation ◽  
Hematopoietic Stem ◽  
Total Body

Renal dysfunction because of radiation exposure was recognized decades ago. The incidence declined when more effective chemotherapeutic agents became available. However, there appears to be a resurgence with the advent of total body irradiation used prior to hematopoietic stem cell transplantation. Several chemotherapeutic drugs used prior to total body irradiation have some ionizing radiation potentiating effects. Chronic kidney disease that occurs after hematopoietic stem cell transplantation is known to occur due to nephrotoxicity from medications, graft-versus-host disease, and the currently under-recognized radiation exposure. The clinical features vary depending on the dose of radiation and the volume of single or bilateral kidneys exposed. The usual symptoms of fatigue, edema, anemia, malignant hypertension, azotemia, and shortness of breath appear in 6–12 months of exposure. Since this is an under-recognized entity, there are no large controlled trials to guide therapy. This review highlights some of the experimental data that have shown some promising results for treatment. There is need for further studies on the current incidence and prevalence and clinical trials to guide treatment, based on the experimental data available.

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