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Updated: May 26, 2026
In Vivo Osteo-organoid Approach for Harvesting Therapeutic Hematopoietic Stem/Progenitor Cells
Published on: February 16, 2024
Osteonecrosis in children after allogeneic hematopoietic cell transplantation: study of prevalence, risk factors and
S Sharma1, W-H Leung, P Deqing
1Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
Insights
Osteonecrosis affects nearly 30% of children after allogeneic hematopoietic stem cell transplant (HCT). Pre-existing osteonecrosis and age at HCT are key risk factors, necessitating preventive strategies before transplant.
Area of Science:
- Pediatric Hematology
- Orthopedic Oncology
- Radiology
Background:
- Osteonecrosis is a known complication of hematopoietic stem cell transplant (HCT).
- Its occurrence and risk factors in pediatric populations undergoing allogeneic HCT (alloHCT) remain understudied.
- Standard follow-up protocols for pediatric alloHCT recipients often lack specific imaging for osteonecrosis.
Purpose of the Study:
- To determine the prevalence and incidence of osteonecrosis in pediatric patients following alloHCT.
- To describe the longitudinal changes and affected anatomical sites of osteonecrosis.
- To identify significant risk factors associated with the development of osteonecrosis post-alloHCT.
Main Methods:
- Retrospective review of magnetic resonance imaging (MR) scans of hips and knees in pediatric patients who underwent alloHCT.
- Analysis of 149 patients with a median follow-up of 32.6 months.
- Statistical analysis to identify risk factors, including age at alloHCT and pre-existing osteonecrosis.
Main Results:
- Osteonecrosis developed in 44 (29.5%) of the analyzed pediatric patients.
- Lesions were most commonly identified within the first three yearly MR scans post-HCT.
- Age at alloHCT and the presence of osteonecrosis before alloHCT were identified as primary risk factors.
Conclusions:
- Osteonecrosis is a significant complication in pediatric alloHCT recipients, with nearly 30% developing the condition.
- Preventive strategies should prioritize mitigating risk factors, particularly pre-existing osteonecrosis and patient age, before undergoing alloHCT.
- Yearly MR imaging of hips and knees is crucial for early detection and monitoring of osteonecrosis in this vulnerable population.
Abstract:
Osteonecrosis after hematopoietic SCT (HCT) has seldom been addressed in pediatric populations. At our institution, since January 2002, children undergoing allogeneic HCT (alloHCT) receive yearly follow-up magnetic resonance imaging (MR) of hips and knees. To estimate the prevalence, longitudinal changes and associated risk factors for osteonecrosis after alloHCT, we reviewed MRs for children who underwent single alloHCT during the study period. We analyzed 149 of 344 patients who had post-HCT MR imaging performed (84 males; median age 11 years (range, 0.5-21 years)), median follow-up time was 32.6 months (range, 2.8-97.2 months). In all, 44 (29.5%) developed osteonecrosis of hips and/or knees; of those, 20 (45%) had at least 30% epiphyseal involvement. In 23 (52%), osteonecrosis lesions were identified in the first and in 43 (98%) by the third yearly scan. Knees were more frequently involved than hips; severity of osteonecrosis was greater in hips. Those who had pre-alloHCT osteonecrosis, two patients' hips and six patients' knees resolved completely; three patients' osteonecrosis lesions regressed after alloHCT. On risk factor analysis, age at time of alloHCT (P=0.051) and osteonecrosis identified by MRs before alloHCT (P=0.001) were the primary risk factors. This analysis shows that preventive strategies for osteonecrosis in this population should focus on measures to minimize risk factors before alloHCT.
