1. ¹Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
2. ²Department of Radiology, University of Tennessee College of Medicine, Memphis, TN, USA
3. ³Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
4. ⁴Department of Hematology-Oncology (Division of Stem Cell Transplantation), St Jude Children's Research Hospital, Memphis, TN, USA
5. ⁵Department of Pediatrics, University of Tennessee College of Medicine, Memphis, TN, USA

Correspondence: Dr SC Kaste, Department of Diagnostic Imaging, St Jude Children's Research Hospital, 332 North Lauderdale, Memphis, TN 38105-2794, USA. E-mail: sue.kaste@stjude.org

Received 11 August 2003; Accepted 24 September 2003; Published online 12 January 2004.

Abstract

Our purpose was to evaluate frequency and severity of bone mineral decrements and frequency of osteonecrosis in survivors of pediatric allogeneic bone marrow transplantation (alloBMT). We retrospectively reviewed demographic information, treatment, magnetic resonance (MR) imaging studies (hips and knees), and bone mineral density (BMD) studies of 48 patients as measured by quantitative computed tomography (QCT). In all, 24 patients were male; 37 were Caucasian. Median age at alloBMT was 10.3 years (1.6–20.4 years). Of the 48 patients, 43 underwent QCT. Median time between alloBMT and imaging was 5.1 years (1.0–10.2 years). Median BMD Z-score was -0.89 (-4.06 to 3.05). BMD Z-score tended to be associated with female sex (P=0.0559) but not with age at BMT, race, primary diagnosis, time from alloBMT, T-cell depletion of graft, total-body irradiation, or acute/chronic graft-versus-host disease (GVHD). MR showed osteonecrosis in 19 of 43 (44%). We found no associations between osteonecrosis and sex, race, diagnosis, age at BMT, history of GVHD, time from BMT, or T-cell depletion. Seven patients (15%) had MR changes of osteonecrosis and BMD Z-scores of less than –1 s.d. We conclude that pediatric alloBMT survivors have decreased BMD and are at risk of osteonecrosis. They should be monitored to assure early intervention that may ameliorate adverse outcomes.