AVASCULAR NECROSIS FOLLOWING BONE-MARROW TRANSPLANTATION - A CASE-CONTROL STUDY

The role of specific immunosuppressive agents in the development of av ascular necrosis (AVN) following hematopoietic stem cell and solid org an transplantation remains unclear, To further explore this question, we conducted a case-control study of patients who underwent bone marro w transplantation (BMT) at the Fred Hutchinson Cancer Research Center, 96 of 1939 long-term survivors transplanted between May 1976 and Octo ber 1993 were identified as having AVN, Eight patients were excluded b ecause AVN developed before transplant and one was excluded due to res trictions on reviewing follow-up records, The remaining 87 patients de veloped AVN a mean of 26.3 +/- 2 months posttransplant and were matche d for age, gender, and date of transplant to other BMT recipients, Rec ords were reviewed for corticosteroid and cyclosporine use, pretranspl ant conditioning with total body irradiation (TBI), and other informat ion including disease for which the transplant was indicated, type of transplant, the occurrence of acute and chronic graft-vs.-host disease , and steroid use prior to transplant, Adjusted odds ratios (ORs) were obtained from conditional logistic regression for 87 matched pairs, P osttransplant steroid use was a risk factor for the occurrence of AVN (adjusted OR, 14.4; 95% CI, 2.8-73.2), with the greatest risk associat ed with those receiving steroids at the time of diagnosis of AVN (adju sted OR, 31.9; 95% CI, 4.4-248.9), There was no further increasing ris k associated with increasing duration of steroid use, Conditioning wit h TBI was also associated with the occurrence of AVN (adjusted OR, 3.2 ; 95% CI, 1.1-9.7); however, cyclosporine was not a risk factor for AV N (adjusted OR, 0.5; 95% CI, 0.1-1.9), Our results support the hypothe sis that AVN following BMT has a strong association with the administr ation of corticosteroids. TBI may be an additional risk factor, and cy closporine does not appear to contribute to an increased incidence of AVN. (C) 1998 by Elsevier Science Inc, All rights reserved.