193: Osteonecrosis in Pediatric Hematopoietic Stem Cell Transplantation

Abstract

Background: Osteonecrosis (ON) is a potentially devastating complication of pediatric hematopoietic stem cell transplantation (HSCT). We report the frequency of symptomatic ON in pediatric patients (pts) who underwent allogeneic HSCT at Children's Hospital Boston/Dana-Farber Cancer Institute over a 6-year period. Methods: We retrospectively reviewed the medical records of 293 consecutive pts who underwent 307 allogeneic HSCTs between January 1, 2000 and December 31, 2006. Diagnosis of ON was based on patient symptoms and confirmed by review of the attending radiologist's final reading of at least one radiographic study. Results: A total of 15 pts (5.1%) developed symptomatic ON. Underlying diagnoses included 5 pts with acute lymphoblastic lymphoma (ALL), 3 acute myeloid leukemia, 1 myelodysplastic syndrome, 3 chronic myeloid leukemia, 2 aplastic anemia, and 1 sickle cell disease. Eleven pts underwent unrelated donor HSCT and 4 had matched sibling transplants. Eleven pts (73%) were ≥10 years of age at the time of HSCT. Thirteen (87%) developed chronic graft-versus-host disease (GVHD), 9 of whom received steroids for over 12 months. The 2 pts without chronic GVHD had an underlying diagnosis of ALL. Two pts underwent a second allogeneic HSCT for relapsed disease and developed ON only after the second transplant. One pt was diagnosed w/ON prior to HSCT with ON that worsened significantly post HSCT. With regard to sites of ON, only 2 pts had a single site (unilateral hip and unilateral knee). Six pts developed bilateral ON of the hips. Of these, 2 pts also had bilateral knee ON (one also with ON of the sacrum). Five additional pts developed bilateral ON of the knees and 2 pts developed bilateral ON of the ankles. Two pts underwent surgical interventions; 1 pt underwent core decompression for bilateral knee ON, and the other, arthroscopy with debridement and drilling of the talus for extensive ankle involvement. Eight of the 15 pts are currently surviving. Four pts are known to have persistent complaints of joint pain. Conclusion: Symptomatic ON developed in 5.1% of pts who underwent allogeneic HSCT. The majority of pts with ON were affected at multiple sites. Further interventional and follow-up studies aimed at identifying those at greatest risk, preventing the complication, and decreasing morbidity from ON are needed in the pediatric HSCT population. Background: Osteonecrosis (ON) is a potentially devastating complication of pediatric hematopoietic stem cell transplantation (HSCT). We report the frequency of symptomatic ON in pediatric patients (pts) who underwent allogeneic HSCT at Children's Hospital Boston/Dana-Farber Cancer Institute over a 6-year period. Methods: We retrospectively reviewed the medical records of 293 consecutive pts who underwent 307 allogeneic HSCTs between January 1, 2000 and December 31, 2006. Diagnosis of ON was based on patient symptoms and confirmed by review of the attending radiologist's final reading of at least one radiographic study. Results: A total of 15 pts (5.1%) developed symptomatic ON. Underlying diagnoses included 5 pts with acute lymphoblastic lymphoma (ALL), 3 acute myeloid leukemia, 1 myelodysplastic syndrome, 3 chronic myeloid leukemia, 2 aplastic anemia, and 1 sickle cell disease. Eleven pts underwent unrelated donor HSCT and 4 had matched sibling transplants. Eleven pts (73%) were ≥10 years of age at the time of HSCT. Thirteen (87%) developed chronic graft-versus-host disease (GVHD), 9 of whom received steroids for over 12 months. The 2 pts without chronic GVHD had an underlying diagnosis of ALL. Two pts underwent a second allogeneic HSCT for relapsed disease and developed ON only after the second transplant. One pt was diagnosed w/ON prior to HSCT with ON that worsened significantly post HSCT. With regard to sites of ON, only 2 pts had a single site (unilateral hip and unilateral knee). Six pts developed bilateral ON of the hips. Of these, 2 pts also had bilateral knee ON (one also with ON of the sacrum). Five additional pts developed bilateral ON of the knees and 2 pts developed bilateral ON of the ankles. Two pts underwent surgical interventions; 1 pt underwent core decompression for bilateral knee ON, and the other, arthroscopy with debridement and drilling of the talus for extensive ankle involvement. Eight of the 15 pts are currently surviving. Four pts are known to have persistent complaints of joint pain. Conclusion: Symptomatic ON developed in 5.1% of pts who underwent allogeneic HSCT. The majority of pts with ON were affected at multiple sites. Further interventional and follow-up studies aimed at identifying those at greatest risk, preventing the complication, and decreasing morbidity from ON are needed in the pediatric HSCT population.