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Avascular necrosis following bone marrow transplantation: a case-control study
J C Fink1, W M Leisenring, K M Sullivan
1Department of Medicine, University of Maryland, Baltimore 21201, USA. jfink@umppal.ab.umd.edu
Bone
|January 23, 1998
Summary
Avascular necrosis (AVN) after bone marrow transplant (BMT) is linked to corticosteroid use. Total body irradiation (TBI) may also increase AVN risk, while cyclosporine does not appear to be a factor.
Area of Science:
- Immunology
- Hematology
- Oncology
Background:
- Avascular necrosis (AVN) is a known complication after transplantation.
- The specific role of immunosuppressive agents in AVN development post-hematopoietic stem cell and solid organ transplantation requires further clarification.
Purpose of the Study:
- To investigate the association between immunosuppressive agents and avascular necrosis (AVN) following bone marrow transplantation (BMT).
Main Methods:
- A case-control study was conducted on long-term survivors of BMT.
- 87 patients with AVN were matched with controls for age, gender, and transplant date.
- Data on corticosteroid and cyclosporine use, total body irradiation (TBI), and graft-vs.-host disease were analyzed using conditional logistic regression.
Main Results:
- Posttransplant corticosteroid use significantly increased the risk of AVN (adjusted OR, 14.4).
- The highest risk was observed in patients receiving steroids at the time of AVN diagnosis (adjusted OR, 31.9).
- Total body irradiation (TBI) was also associated with an increased risk of AVN (adjusted OR, 3.2), while cyclosporine showed no significant association (adjusted OR, 0.5).
Conclusions:
- Corticosteroid administration is strongly associated with AVN development after BMT.
- TBI may be an additional risk factor for AVN post-BMT.
- Cyclosporine does not appear to contribute to the incidence of AVN following BMT.