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Bone morphology after bone marrow transplantation for Hodgkin's and non-Hodgkin's lymphoma
J D Michelson1, M Gornet, T Codd
1Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Bone marrow ablation and transplantation for lymphoma significantly reduces osteocyte viability for weeks. Marrow fibrosis increases while cellularity decreases post-transplant, impacting bone health.
Area of Science:
- Hematology
- Oncology
- Bone Biology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for hematologic malignancies like Hodgkin's and non-Hodgkin's lymphoma.
- The long-term effects of BMT on bone homeostasis, particularly osteocyte viability, remain incompletely understood.
Purpose of the Study:
- To investigate the osteogenic consequences of bone marrow ablation and transplantation in lymphoma patients.
- To assess changes in osteocyte viability, marrow cellularity, and fibrosis following BMT.
Main Methods:
- Retrospective review of iliac crest bone biopsies from 69 lymphoma patients (37 non-Hodgkin's, 32 Hodgkin's) pre- and post-BMT.
- Histomorphometric analysis to quantify osteocyte viability, marrow cellularity, and marrow fibrosis.
- Comparison of outcomes based on lymphoma type, treatment regimen (chemotherapy alone vs. total body irradiation plus chemotherapy), and transplant type (allogeneic).
Main Results:
- Osteocyte viability, estimated by filled trabecular lacunae, decreased for over four weeks post-BMT.
- Observed ongoing osteocyte loss centrally within trabeculae, with new osteocyte formation at the periphery.
- Significant increases in marrow fibrosis and decreases in marrow cellularity were noted.
- No significant differences in bone changes were found based on lymphoma type, pretransplant regimen, or transplant type.
Conclusions:
- Disruption of marrow hematopoiesis through ablation and BMT leads to a marked reduction in osteocyte viability.
- While early new osteogenesis occurs, the source of progenitor cells is not identifiable from this study.
- These findings highlight potential long-term skeletal complications following BMT for lymphoma.
Abstract:
The osteogenic consequences of bone marrow ablation followed by bone marrow transplantation for Hodgkin's and non-Hodgkin's lymphoma were examined. Pre- and post-transplantation iliac crest bone biopsies were reviewed for all patients undergoing transplantation at the Johns Hopkins Oncology Center between January 1981 and December 1989. Histomorphometric measurements included percentage of filled trabecular lacunae to estimate osteocyte viability, marrow cellularity and marrow fibrosis. A total of 37 non-Hodgkin's and 32 Hodgkin's patients had adequate biopsies for study inclusion. Twenty-seven received chemotherapy alone, while the remaining 42 had lethal total body irradiation plus chemotherapy. Twelve transplants were allogeneic. Estimated osteocyte viability was decreased for over 4 weeks after bone marrow transplantation. Continuing osteocyte dropout in the central regions of trabeculae was seen in conjunction with active new osteocyte formation along the periphery. Marrow fibrosis was significantly increased and marrow cellularity decreased. There were no major distinctions based on lymphoma type, pretransplant treatment regimen or type of bone marrow transplant. The results indicate that disruption of marrow hematopoiesis causes a diminution in osteocyte viability. Although there is an early appearance of new osteogenesis, the source of progenitor cells cannot be determined from this study.