Khaire Niranjan S, Dinesan Arjun, Sinha Anindita, Bhadada Sanjay, Malhotra Pankaj, Khadwal Alka, Prakash Gaurav, Jain Arihant, Jandial Aditya, Lad Deepesh P
Department of Internal Medicine.
Radiodiagnosis.
Blood Cell Ther. 2021 Aug 25;4(3):48-53. doi: 10.31547/bct-2020-019.
There is a lack of prospective studies to address the issue of timing of bone mineral density (BMD) measurement and anti-resorptive therapy before and after allogeneic hematopoietic cell transplantation (allo-HCT), specifically in the younger population (age < 40 years). This study evaluated the incidence and risk factors of poor BMD in young Indian patients undergoing allogeneic hematopoietic cell transplant and the effect of anti-resorptive therapy in allogeneic transplant recipients who are at high risk for severe bone loss.
This was a single-center, prospective study conducted from 2016 to 2019. All patients aged ≥ 12 years undergoing allo-HCT were included in the study. Data regarding the risk factors for osteoporosis, underlying diagnoses, and HCT characteristics were recorded. BMD was measured by dual-energy X-ray absorptiometry (DXA) (HOLOGIC Discovery A) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) at pre-HCT, day+100, and day+365 post-HCT. Patients with Z-score ≤ -2 at day+100 were given one dose (4 mg) of intravenous zoledronate. Patients with moderate to severe chronic graft-versus-host disease (GVHD) also received a dose of zoledronate if they had not received it earlier.
The median age of our cohort was 24 years (IQR 18.5 - 39.5). Day+100 DXA was available for 25 (54.3%) patients, a paired day+100, and day+365 DXA was available for 15 patients. For pre-HCT, a Z-score ≤ -2 was seen in 30% of patients. For day+100 post-HCT, a Z-score ≤ -2 was seen in 44% of patients. Low body mass index was associated with a Z-score ≤ -2 (median 18 vs. 23 kg/m, = 0.04). Despite a single dose of zoledronate in this cohort, the median Δ BMD (day+365 - day+100) loss at FN and LS was -0.8% to -3.7%, respectively. Seven (64%) of these patients also had moderate-severe chronic GVHD.
BMD below the expected range for age (Z-score ≤ -2) was present in one-third of young Indian patients undergoing allo-HCT in this single center study. Without intervention, up to half of the patients had a Z-score ≤ -2 at day+100 post-HCT. BMD loss at day+100 persisted at day+365 despite anti-resorptive therapy.
缺乏前瞻性研究来探讨异基因造血细胞移植（allo-HCT）前后骨密度（BMD）测量及抗吸收治疗的时机问题，尤其是在年轻人群（年龄<40岁）中。本研究评估了接受异基因造血细胞移植的年轻印度患者中骨密度不佳的发生率和危险因素，以及抗吸收治疗对有严重骨质流失高风险的异基因移植受者的影响。
这是一项于2016年至2019年进行的单中心前瞻性研究。所有年龄≥12岁接受allo-HCT的患者均纳入研究。记录有关骨质疏松症危险因素、潜在诊断和造血细胞移植特征的数据。在移植前、移植后第100天和第365天，采用双能X线吸收法（DXA）（HOLOGIC Discovery A）测量腰椎（LS）、股骨颈（FN）和全髋（TH）的骨密度。移植后第100天Z评分≤-2的患者给予一剂（4mg）静脉注射唑来膦酸。中度至重度慢性移植物抗宿主病（GVHD）患者若此前未接受过唑来膦酸治疗，也给予一剂。
我们队列的中位年龄为24岁（四分位间距18.5 - 39.5）。25例（54.3%）患者有移植后第100天的DXA数据，15例患者有配对的移植后第100天和第365天的DXA数据。移植前，30%的患者Z评分≤-2。移植后第100天，44%的患者Z评分≤-2。低体重指数与Z评分≤-2相关（中位数18 vs. 23 kg/m²，P = 0.04）。尽管该队列中患者接受了一剂唑来膦酸，但股骨颈和腰椎的骨密度中位数变化（移植后第365天 - 移植后第100天）损失分别为-0.8%至-3.7%。这些患者中有7例（64%）也患有中度至重度慢性GVHD。
在这项单中心研究中，三分之一接受allo-HCT的年轻印度患者骨密度低于年龄预期范围（Z评分≤-2）。未经干预的情况下，高达一半的患者在移植后第100天Z评分≤-２。尽管进行了抗吸收治疗，移植后第100天的骨密度损失在移植后第365天仍持续存在。
