AVASCULAR NECROSIS OF BONE FOLLOWING ALLOGENEIC STEM-CELL TRANSPLANTATION - MR SCREENING AND THERAPEUTIC OPTIONS

With improvement in long-term survival after allogeneic stem cell tran splantation, late complications with significant morbidity are of incr easing importance, We retrospectively analysed 272 recipients of an al logeneic stem ceh transplant for the development of osteonecrosis, The incidence among allograft recipients was 6.3% (17/272) for the whole patient population, and 11.8% (17/144) for long-term survivors. All pa tients were treated with high-dose prednisolone, 16 for severe acute o r extensive chronic graft-versus-host disease (GVHD) and one patient f or graft rejection. The mean age at time of diagnosis was 33 years (ra nge 16-45) and the mean time from transplant to diagnosis of osteonecr osis was 13 months. Osteonecrosis was diagnosed by magnetic resonance (MR) imaging, which allows early detection of osteonecrosis and assess ment of stage. At the time of diagnosis, eight patients had stage I, t hree patients stage II, three patients stage III and three patients st age ni osteonecrosis according to MR criteria. All but one patient had involvement of the femoral head. The median total dosage of prednisol one at the time of diagnosis was 189 mg/kg (single manifestation 150 m g/kg; multiple manifestations 313 mg/kg) with a total range of 13-555 mg/kg, Six patients were treated by conservative means, 77 patients un derwent surgery (three core decompression, eight joint replacement), M R screening of patients receiving high-dose steroids might help to det ect osteonecrosis at an early stage and thus prevent progression by ea rly intervention, for example, by core decompression.