Early changes in bone mineral density and trabecular bone score following allogeneic stem cell transplant

Pawłowska, Monika; Yang, Qiong; Hamata, Basia; Kendler, David L.; Broady, Raewyn

doi:10.1038/bmt.2015.329

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…More than 50% of patients had normal BMD at baseline and the proportion of patients with normal BMD did not significantly change after transplant ( Table 4 ). These results contrast data from our previous study which revealed a significant decline in femoral neck BMD, and increased frequency of both osteopenia and osteoporosis at day 100 post-transplant [ 10 , 37 ]. The low prevalence of osteoporosis in the present study cohort may have impaired our ability to detect bone loss in both groups by day 100 [ 9 ].…”

Section: Discussioncontrasting

confidence: 99%

Loading dose vitamin D3 improves vitamin D insufficiency in adults undergoing hematopoietic stem cell transplantation: A randomized controlled trial

Bai,

Lee,

Limvorapitak

et al. 2023

PLoS ONE

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Allogeneic hematopoietic stem cell transplant (aHSCT) patients are well known to be at high risk of vitamin D (vit D) deficiency. This study assessed whether a loading dose (100,000 IU) of vitamin D3 pre-aHSCT could effectively achieve and maintain sufficient post-transplant vit D levels (serum total 25 hydroxy vitamin D (25(OH)D) ≥ 75nmol/L). Dual-energy X-ray absorptiometry (DXA) was also conducted for bone health evaluation. 74 patients were enrolled and randomly assigned, in a 1:1 ratio, either to the high vit D group (single loading dose (100,000 IU) plus 2,000 IU vit D3 daily) or the control group (2,000 IU vit D3 daily). Vit D levels were measured at three time points (baseline, day 30 and day 100 post-aHSCT). At baseline, fewer than 50% patients had a sufficient 25(OH)D (control: 42.9%; high vit D: 43.6%). The proportion of patients with sufficient 25(OH)D (nmol/L) was increased at day 30 and day 100, with a trend of higher proportion in the high vit D group at day 30 (high vit D vs. control: 89.7% vs. 74.3%, p = 0.08). The increased 25(OH)D was significantly higher in the high vit D group at day 30 (high vit D vs. control: 29±25.2 vs. 14 ±21.9, p = 0.01). Insufficient vit D level before transplant (baseline) was an independent risk factor for vit D insufficiency (serum 25(OH)D < 75nmol/L) post-aHSCT (OR = 4.16, p = 0.03). DXA suggested significant bone loss for total hip in both groups, and in the femoral neck for the control group only. In conclusion, single loading dose vitamin D3 significantly increased total 25(OH)D levels at day 30 post-transplant, and the intervention was especially beneficial for patients with baseline vit D insufficiency. We acknowledge that the primary outcome at day 100 post-aHSCT indicating superiority of loading dose versus daily dose supplementation was not met.

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Section: Discussioncontrasting

confidence: 99%

Loading dose vitamin D3 improves vitamin D insufficiency in adults undergoing hematopoietic stem cell transplantation: A randomized controlled trial

Bai,

Lee,

Limvorapitak

et al. 2023

PLoS ONE

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“…Few studies have looked at early BMD loss post-HCT around day+100 and have reported an osteopenia (T-score < -1 and > -2.5)/osteoporosis (T-score -2.5) at a combined rate of 48% to 68% 5,6 . Both of these studies used the WHO definition for reporting BMD, as they were published before the recent ISCD official position on reporting BMD in the younger population that recommended the use of Z-scores 12 .…”

Section: Study Interventionsmentioning

confidence: 99%

“…Despite the differences in BMD terminology, patients in our cohort had a near equivalent incidence (44%) of BMD below the expected range for age (Zscore -2). Only one of the above studies looked at pre-HCT BMD and reported the prevalence of osteopenia/osteoporosis to be 53% 6 . In our study, 30% of the patients had a Z-score -2 pre-HCT.…”

Section: Study Interventionsmentioning

confidence: 99%

“…These recommendations were based on observations that suggested that nadir bone mineral density (BMD) loss occurred at six months to one year 3,4 . However, a few studies have indicated that BMD loss may occur earlier than six months and as early as three months post-HCT 5,6 . Recently, the International Osteoporosis Foundation Working Group on Cancer and Bone Disease also recommended DXA at 3-months post-HCT 7 .…”

mentioning

confidence: 99%

“…Recently, the International Osteoporosis Foundation Working Group on Cancer and Bone Disease also recommended DXA at 3-months post-HCT 7 . Although there is an evolving consensus on when to do DXA scans, there is no consensus on the timing for pharmacologic intervention based on T-score/Z-score cutoffs or percentage BMD loss in the younger population (age < 40 years) in the post-HCT setting 3,6 . The ASTCT guidance proposes starting pharmacologic therapy in those < 40years of age receiving prednisone equivalent doses of 7.5 mg/day for 6 months and either exhibiting fragility fractures, Z-score < -3.0, or 10% BMD loss over a year 1 .…”

mentioning

confidence: 99%

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Successful treatment with lenalidomide for relapsed adult T-cell leukemia/lymphoma after cord blood cell transplantation

Khaire¹,

Dinesan²,

Sinha³

et al. 2021

BCT

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Background: 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. Methods: 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. Results: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 2 , P = 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. Conclusions: 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 Zscore -2 at day+100 post-HCT. BMD loss at day+100 persisted at day+365 despite anti-resorptive therapy.

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Posttransplantation bone disease: prevalence, surveillance, prevention, and management

Duncan

2021

Blood and Marrow Transplantation Long Term Management

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Early changes in bone mineral density and trabecular bone score following allogeneic stem cell transplant

Cited by 8 publications

References 15 publications

Loading dose vitamin D3 improves vitamin D insufficiency in adults undergoing hematopoietic stem cell transplantation: A randomized controlled trial

Loading dose vitamin D3 improves vitamin D insufficiency in adults undergoing hematopoietic stem cell transplantation: A randomized controlled trial

Successful treatment with lenalidomide for relapsed adult T-cell leukemia/lymphoma after cord blood cell transplantation

Posttransplantation bone disease: prevalence, surveillance, prevention, and management

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