Lu Huifang, Champlin Richard E, Popat Uday, Pundole Xerxes, Escalante Carmelita P, Wang Xuemei, Qiao Wei, Murphy William A, Gagel Robert F
Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA.
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center , Houston, TX, USA.
Bonekey Rep. 2016 Oct 19;5:843. doi: 10.1038/bonekey.2016.72. eCollection 2016.
The purpose of this study was to evaluate the effects of ibandronate on bone loss following allogeneic stem cell transplantation (allo-SCT). A single-centered, open-label prospective randomized-controlled study following allo-SCT. The treatment group received 3 mg of intravenous ibandronate quarterly starting within 45 days of allo-SCT. All patients received daily calcium and vitamin D supplements. We compared the changes in bone mineral density (BMD) in the lumbar spine, femoral neck and total hip at 6 and 12 months following allo-SCT between the control and treatment groups. We also assessed relationships between bone loss and cumulative glucocorticoid dose, cumulative tacrolimus dose and acute and chronic graft-versus-host disease (GVHD) by linear regression. In all, 78 patients were enrolled. The treatment group had significantly less BMD loss in the lumbar spine at 6 months (mean percent change 0.06±4.03 (treatment group) versus -2.61±4.2 (control group)) and 12 months (mean percent change 1.27±5.29 (treatment group) versus -1.81±4.49 (control group)) than the control group (=0.03). Both groups lost more BMD in the femoral neck and total hip than in the lumbar spine at 6 and 12 months. The changes in BMD in the femoral neck and total hip did not differ significantly between groups. Both glucocorticoids and tacrolimus reduced BMD in the lumbar spine, but ibandronate prevented this loss. Ibandronate may reduce bone loss in the lumbar spine in patients who undergo allo-SCT, particularly those who have received high doses of glucocorticoids and/or tacrolimus.
本研究的目的是评估伊班膦酸钠对异基因干细胞移植（allo-SCT）后骨质流失的影响。这是一项allo-SCT后的单中心、开放标签前瞻性随机对照研究。治疗组在allo-SCT后45天内开始每季度静脉注射3毫克伊班膦酸钠。所有患者每日补充钙和维生素D。我们比较了对照组和治疗组在allo-SCT后6个月和12个月时腰椎、股骨颈和全髋部的骨密度（BMD）变化。我们还通过线性回归评估了骨质流失与糖皮质激素累积剂量、他克莫司累积剂量以及急慢性移植物抗宿主病（GVHD）之间的关系。总共招募了78名患者。治疗组在6个月时腰椎的BMD损失明显少于对照组（平均变化百分比0.06±4.03（治疗组）对-2.61±4.2（对照组）），在12个月时也是如此（平均变化百分比1.27±5.29（治疗组）对-1.81±4.49（对照组））（=0.03）。在6个月和12个月时，两组在股骨颈和全髋部的BMD损失均比腰椎更多。两组在股骨颈和全髋部的BMD变化无显著差异。糖皮质激素和他克莫司均会降低腰椎的BMD，但伊班膦酸钠可防止这种损失。伊班膦酸钠可能会减少接受allo-SCT患者腰椎的骨质流失，尤其是那些接受过高剂量糖皮质激素和/或他克莫司的患者。
