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Transplant Toxicities

Factors influencing the late phase of recovery after bone mineral density loss in allogeneic stem cell transplantation survivors

Bone Marrow Transplantation volume 51, pages 1101–1106 (2016)Cite this article

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Abstract

Accelerated bone mineral density loss (BMDL) occurs early after allogeneic stem cell transplantation (SCT) and is related to factors such as steroids and chronic GvHD. In order to understand the natural history of BMDL of SCT in the longer term, we evaluated a longitudinal cohort of 148 survivors with a median follow-up of 12 years (range 3–22 years). All women received hormone replacement therapy, and routine calcium/vitamin D supplementation was recommended but ∼50% of patients still had suboptimal vitamin D levels and bisphosphonates were rarely utilized. BMD significantly improved from 5 to 20+ years but the femoral neck and forearm remained vulnerable sites. Younger age, higher pretransplant body mass index (BMI) and increment in BMI post transplant were significantly associated with increased BMD and protected against osteopenia/osteoporosis. These findings support consideration of BMD loss in SCT survivors in two phases, an early phase of BMD loss (3–5 years) followed by a later phase of BMD recovery, with different protective and aggravating factors. Treatment- and transplant-related factors (such as steroids, immunosuppressives, chronic GvHD, vitamin D) are known to impact the early phase of BMD loss but age and BMI are more influential in the late phase of BMD recovery.

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Acknowledgements

This work was supported by the Intramural Research Program of the NHLBI, NIH.

Author contributions

PA designed the study, collected data, analyzed and interpreted the data and wrote the manuscript; NAJ and PAP collected data and critically revised the manuscript; XT analyzed and interpreted the data and critically revised the manuscript; COW analyzed the data; BNS critically revised the manuscript; EK and SI took care of patients and critically revised the manuscript; JB and MB designed the study, analyzed and interpreted the data, wrote the manuscript and took care of patients.

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Authors and Affiliations

  1. Hematology Branch, NHLBI, NIH, Bethesda, MD, USA

    P Anandi, N A Jain, P A Pophali, E Koklanaris, S Ito, J Barrett & M Battiwalla

  2. Office of Biostatistics Research, NHLBI, NIH, Bethesda, MD, USA

    X Tian & C O Wu

  3. Vanderbilt University Medical Center, Nashville, TN, USA

    B N Savani

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  1. P Anandi
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  2. N A Jain
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  3. X Tian
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Correspondence to M Battiwalla.

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Anandi, P., Jain, N., Tian, X. et al. Factors influencing the late phase of recovery after bone mineral density loss in allogeneic stem cell transplantation survivors. Bone Marrow Transplant 51, 1101–1106 (2016). https://doi.org/10.1038/bmt.2016.85

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