213 Bone Mineral Density (BMD) Improves in Survivors in Their Second Decade Post-Allogeneic Stem Cell Transplantation and Is Influenced By Body Mass Index (BMI) and Age

Track: Poster Abstracts
Wednesday, February 11, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Prathima Anandi, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Natasha A Jain, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Colin Wu, Phd , Office of Biostatistics Research, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Xin Tian, PhD , Office of Biostatistics Research, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Priyanka A Pophali, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Eleftheria Koklanaris, RN , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Neil Dunavin, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Sawa Ito, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Robert Q Le, MD, Phd , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Bipin N. Savani, MD , Vanderbilt University Medical Center, Nashville, TN
A. John Barrett, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Minoo Battiwalla, MD, MS , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Presentation recording not available for download or distribution as requested by the presenting author.

Introduction: Rapid and profound BMD loss occur in the first year after allogeneic stem cell transplantation (SCT) and attributed to steroid exposure, chronic GVHD (cGVHD), conditioning, age and gender. However, changes in BMD in very long-term survivors are not well understood. We evaluated survivors by serial DEXA scans to determine the kinetics as well as to identify the factors influencing long term BMD beyond 3 years post SCT.

Patients and Methods: 148 subjects (85 male and 63 female) underwent HLA-identical sibling SCT between 1993 and 2011. 58 survivors were informative at 10+ years and 19 at 15+ years. The median age at transplant was 36 years. Diagnoses at transplant included CML (62), AML/MDS (56), ALL (16), NHL/CLL (8) and others (6). 88% patients received 12-13 Gy TBI-based conditioning followed by an ex vivo T cell depleted SCT while 12% received reduced intensity conditioning and a T replete graft.  The graft source was peripheral blood in 133 (90%) and marrow in 15(10%) patients. Hormone replacement (in women), Calcium and vitamin D were routinely supplemented but bisphosphonates were avoided. Survivors were categorized by their lowest T-score as normal BMD (≥ -1), osteopenia (< -1 and > -2.5) or osteoporosis (≤ -2.5) (WHO criteria). A T-score < -1.0 was defined as bone loss (BL). Univariate and multivariable analyses were conducted to evaluate the time-trend in BMD, the trends in proportions of subjects with BL and the influence of age, gender, conditioning intensity, cGVHD, prolonged cGVHD (requiring systemic immunosuppression at 3 years), a diagnosis of ALL, and body mass index (BMI).

Results: At the start of analysis (3 years post SCT), significant BL had already occurred in 75%: 56 % had osteopenia and 19% were osteoporotic. The forearm and spine followed by the femur were the most common sites of osteoporosis. Follow-up DEXA scans at 5+, 10+ and 15+ years showed significant changes in % with BL and in T-scores (figure A). The lowest T-scores and BMD at various sites showed significant increases between 5 and 10 years.  The femoral neck had the lowest BMD between 5 and 15 years, significantly lower (p<0.05) compared to other sites apart from the forearm.

In multivariable analyses for BMD loss and osteoporosis, bone loss was more severe with increasing age and lower BMI but was not influenced by gender, any history of cGVHD, prolonged cGVHD, Intensity of conditioning regimen, primary diagnosis (ALL vs other) or stem cell source.

Conclusions: BMD stabilized between 3 and 5 years and gradually improved between 5-15 years in our long-term survivors without bisphosphonates. The femoral neck is an anatomical site that remained vulnerable to prolonged decline in BMD. Age and BMI (reflecting general health or nutritional status, figure B) were more influential in long-term survivors than variables indicating tissue injury, cGVHD or steroids.

A.

 

 

 

 

 

 

B.

Disclosures:
Nothing To Disclose
See more of: Poster Session 1: Late Effects/Quality of Life/Psychosocial Issues
See more of: Poster Abstracts
<< Previous Presentation | Next Presentation >>