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Pre- and post-magnetic resonance imaging of hips and knees for detecting osteonecrosis in children and adolescents undergoing hematopoietic cell transplantation

Bone Marrow Transplantation volume 55, pages 1837–1839 (2020)Cite this article

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Osteonecrosis (ON) is a debilitating complication in survivors of allogeneic hematopoietic cell transplantation (HCT). Early detection may allow intervention to prevent extensive erosion of articular surface necessitating surgery and joint replacement.

Magnetic resonance imaging (MRI) is the most sensitive modality for detection of ON [1, 2]. Studies at our institution reported ON pre-HCT identified by MRI, older age, and decreased bone mineral density (BMD) as risk factors for ON post-HCT [3,4,5]. Other studies reported older age, high body mass index (BMI), graft-versus-host disease (GVHD), steroid use, and total-body irradiation (TBI)-based conditioning as risk factors for ON post-HCT [6, 7]. However, previous studies are limited by diverse diagnostic criteria for ON with inclusion of patients with metaphyseal, diaphyseal and punctate joint involvement, and ON at all sites.

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Fig. 1: Outcome of patients screened for hip osteonecrosis (ON) pre- and post-hematopoietic cell transplantation (HCT) by magnetic resonance imaging (MRI).

References

  1. Karimova EJ, Rai SN, Deng X, Ingle DJ, Ralph AC, Neel MD, et al. MRI of knee osteonecrosis in children with leukemia and lymphoma: part 1, observer agreement. AJR. 2006;186:470–6.

    Article  Google Scholar 

  2. Karimova EJ, Rai SN, Ingle D, Ralph AC, Deng X, Neel MD, et al. MRI of knee osteonecrosis in children with leukemia and lymphoma: part 2, clinical and imaging patterns. AJR. 2006;186:477–82.

    Article  Google Scholar 

  3. Kaste SC, Shidler TJ, Tong X, Srivastava DK, Rochester R, Hudson MM, et al. Bone mineral density and osteonecrosis in survivors of childhood allogeneic bone marrow transplantation. Bone Marrow Transplant. 2004;33:435–41.

    Article  CAS  Google Scholar 

  4. Sharma S, Yang S, Rochester R, Britton L, Leung WH, Yang J, et al. Prevalence of osteonecrosis and associated risk factors in children before allogeneic BMT. Bone Marrow Transplant. 2011;46:813–9.

    Article  CAS  Google Scholar 

  5. Sharma S, Leung WH, Deqing P, Yang J, Rochester R, Britton L, et al. Osteonecrosis in children after allogeneic hematopoietic cell transplantation: study of prevalence, risk factors and longitudinal changes using MR imaging. Bone Marrow Transplant. 2012;47:1067–74.

    Article  CAS  Google Scholar 

  6. Faraci M, Calevo MG, Lanino E, Caruso S, Messina C, Favre C, et al. Osteonecrosis after allogeneic stem cell transplantation in childhood. A case-control study Italy. Haematologica. 2006;91:1096–9.

    PubMed  Google Scholar 

  7. Fink JC, Leisenring WM, Sullivan KM, Sherrard DJ, Weiss NS. Avascular necrosis following bone marrow transplantation: a case-control study. Bone. 1999;22:67–71.

    Article  Google Scholar 

  8. Karimova EJ, Rai SN, Howard SC, Neel MD, Britton L, Pui CH, et al. Femoral head osteonecrosis in pediatric and young adult patients with leukemia or lymphoma. J Clin Oncol. 2007;25:1525–31.

    Article  Google Scholar 

  9. Kaste SC, Pei D, Cheng C, Neel MD, Bowman P, Ribeiro RC, et al. Utility of early screening magnetic resonance imaging for extensive hip osteonecrosis in pediatric patients treated with glucocorticoids. J Clin Oncol. 2015;33:610–5.

    Article  Google Scholar 

  10. Kuhlen M, Bader P, Sauer M, Albert MH, Gruhn B, Gungor T, et al. Low incidence of symptomatic osteonecrosis after allogeneic HSCT in children with high-risk or relapsed ALL-results of the ALL-SCT 2003 trial. Br J Haematol. 2018;183:104–9.

    Article  Google Scholar 

  11. Girard P, Auquier P, Barlogis V, Contet A, Poiree M, Demeocq F, et al. Symptomatic osteonecrosis in childhood leukemia survivors: prevalence, risk factors and impact on quality of life in adulthood. Haematologica. 2013;98:1089–97.

    Article  CAS  Google Scholar 

  12. Li X, Brazauskas R, Wang Z, Al-Seraihy A, Baker KS, Cahn J-Y, et al. Avascular necrosis of bone after allogeneic hematopoietic cell transplantation in children and adolescents. Biol Blood Marrow Transplant. 2014;20:587–92.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Kimberly Johnson from the Department of Radiology at St. Jude for assistance in collecting data.

Funding

This work was supported by NCI Cancer Center CORE Support Grant P30 CA 21765 and by ALSAC.

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Author notes

  1. These authors contributed equally: Sue Kaste, Ali Y. Suliman

Authors and Affiliations

  1. Department of Radiology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Sue Kaste

  2. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Sue Kaste

  3. Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Ali Y. Suliman, Ying Li, Dinesh Keerthi, Brandon Triplett & Ashok Srinivasan

  4. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Guolian Kang

  5. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA

    Brandon Triplett & Ashok Srinivasan

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  1. Sue Kaste
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Correspondence to Ashok Srinivasan.

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Kaste, S., Suliman, A.Y., Li, Y. et al. Pre- and post-magnetic resonance imaging of hips and knees for detecting osteonecrosis in children and adolescents undergoing hematopoietic cell transplantation. Bone Marrow Transplant 55, 1837–1839 (2020). https://doi.org/10.1038/s41409-020-0882-9

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