AVASCULAR NECROSIS OF BONE AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION - CLINICAL FINDINGS, INCIDENCE AND RISK-FACTORS

In the present study we describe the incidence, clinical course, and m anagement of avascular necrosis of bone following allogeneic bone marr ow transplantation, and identify risk factors related to its developme nt. All patients developing avascular necrosis of bone after allogenei c bone marrow transplantation between January 1974 and September 1992 were included in the analysis and were studied using the Hopital Saint Louis Bone Marrow Transplant Database and hospital records. 27/727 al logeneic transplant recipients developed avascular necrosis leading to an 8.1% incidence at 5 years, by product limit estimate, ranging from 5% to 11.2%. Symptoms developed 119-1747 d (median 398 d) after trans plantation. In these 27 patients a total of 52 joints were affected (m ean 1.92 per patient, range 1-7). The hip joint was most often affecte d (69% of patients). All patients had joint pain that led to diagnosis by means of standard radiographs with or without the help of techneti um-99 scans and/or magnetic resonance imaging. All but three patients received steroid therapy for acute graft-versus-host disease. Among 10 factors tested, three were shown to be significantly linked to an inc reased risk for developing avascular necrosis by multivariate analysis : male gender (relative risk (RR) 4.72, P = 0.002), age older than 16 (RR = 3.87, P = 0.004), and acute graft-versus-host disease requiring steroid therapy (RR = 6.30, P = 0.0002). 10 patients (37%) required jo int replacement within 19 months (range 2-42) following diagnosis of a vascular necrosis. In conclusion, avascular necrosis of bone is a freq uent late complication of allogeneic bone marrow transplantion causing significant morbidity and requiring replacement surgery in one-third of affected patients. In this 18-year single-centre survey, older age, male gender and steroid therapy given for acute graft-versus-host dis ease were shown to independently increase the risk of avascular necros is of bone.