异基因干细胞移植后骨密度的变化。

Changes in bone mineral density after allogenic stem cell transplantation.

机构信息

Department of Rheumatology, Lille University Hospital, 59000 Lille, France.

Department of Hematology, Lille University Hospital, 59000 Lille, France.

出版信息

Joint Bone Spine. 2022 Oct;89(5):105373. doi: 10.1016/j.jbspin.2022.105373. Epub 2022 Mar 5.

DOI:10.1016/j.jbspin.2022.105373

PMID:35259477

Abstract

OBJECTIVE

Osteoporosis is a complication after allogenic stem cell transplantation (alloSCT). The purpose of this study was to assess changes in bone mineral density (BMD) 6 months and 3 years after alloSCT, as well as predictors of bone loss.

METHODS

A longitudinal, prospective, single-center study was conducted at Lille University Hospital between 2005 and 2016. Clinical, biological, radiologic (thoracic and lumbar spine) and densitometric (DXA) assessments were carried out at baseline (pre-transplant), 6 months and 3 years. Patients with myeloma were not included.

RESULTS

Two hundred and fifty-eight patients were included (144 men). Among them, 60.1% had leukemia and 65.8% of them, acute myeloid leukemia. At baseline, 6 months and 3 years, DXA-confirmed that osteoporosis was observed in 17%, 22.8% and 17.5% of the patients, respectively, mainly at the femoral neck. At baseline, 6 months and 3 years, 9 (8.5%), 53 (21.5%) and 38 (16.7%) patients, respectively, were receiving anti-osteoporotic treatment. From baseline to 6-month follow-up, BMD decreased significantly (p<0.001) at the lumbar spine (-36 [95%CI; -51 to -20] mg/cm of hydroxyapatite), femoral neck (-43 [95%CI; -57 to -29] mg/cm of hydroxyapatite) and total hip (-53 [95%CI; -68 to -39] mg/cm of hydroxyapatite). From 6-month to 3-year follow-up, a significant increase in BMD was observed at the lumbar spine only (+31 [95%CI; 20 to 42] mg/cm of hydroxyapatite, p<0.001). At all 3 sites, changes in BMD did not differ between patients treated or untreated by anti-osteoporotic treatment from 6-month to 3 year follow-up. Incident fractures were found in 4.1% and 5.7% of the patients at 6 months and 3 years, respectively. Between baseline and 6 months, bone loss at all 3 sites was associated with corticosteroid intake. At the total hip, 23.3% of the decrease in BMD from baseline to 6 months was due to an active hematological disease (p<0.05), a bone marrow stem cells (p<0.01) and a corticosteroid intake (p<0.01).

CONCLUSION

Our study found evidence of bone fragility in alloSCT patients. Low BMD persisted at the hip 3 years after transplantation due to slower improvement at this site.

摘要

目的

异体干细胞移植（alloSCT）后会发生骨质疏松症。本研究的目的是评估 alloSCT 后 6 个月和 3 年时骨密度（BMD）的变化，并预测骨质流失的情况。

方法

这是一项在 2005 年至 2016 年期间在里尔大学医院进行的纵向、前瞻性、单中心研究。在基线（移植前）、6 个月和 3 年时进行临床、生物学、影像学（胸椎和腰椎）和骨密度（DXA）评估。未纳入多发性骨髓瘤患者。

结果

共纳入 258 例患者（男性 144 例）。其中，60.1%为白血病患者，65.8%为急性髓性白血病患者。在基线、6 个月和 3 年时，DXA 证实分别有 17%、22.8%和 17.5%的患者患有骨质疏松症，主要发生在股骨颈。在基线、6 个月和 3 年时，分别有 9（8.5%）、53（21.5%）和 38（16.7%）例患者接受了抗骨质疏松治疗。从基线到 6 个月的随访期间，BMD 在腰椎（-36 [95%CI；-51 至-20] mg/cm 羟磷灰石）、股骨颈（-43 [95%CI；-57 至-29] mg/cm 羟磷灰石）和全髋（-53 [95%CI；-68 至-39] mg/cm 羟磷灰石）显著降低（p<0.001）。从 6 个月到 3 年的随访期间，仅在腰椎观察到 BMD 显著增加（+31 [95%CI；20 至 42] mg/cm 羟磷灰石，p<0.001）。在所有 3 个部位，从 6 个月到 3 年的随访期间，接受或未接受抗骨质疏松治疗的患者之间的 BMD 变化没有差异。在 6 个月和 3 年时，分别有 4.1%和 5.7%的患者发生新发骨折。在基线和 6 个月之间，所有 3 个部位的骨质流失均与皮质类固醇的摄入有关。在全髋，从基线到 6 个月 BMD 下降的 23.3%归因于活跃的血液疾病（p<0.05）、骨髓干细胞（p<0.01）和皮质类固醇摄入（p<0.01）。