1. Moderate-severe grade of chronic graft versus host disease and younger age (less than 45 years old) are risk factors for avascular necrosis in adult patients undergoing allogeneic hematopoietic cell transplantation.
- Author
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Law, Arjun Datt, Bhella, Sita, Pasic, Ivan, Lam, Wilson, Michelis, Fotios V., Gerbitz, Armin, Viswabandya, Auro, Kumar, Rajat, Lipton, Jeffrey H., Mattsson, Jonas, and Kim, Dennis Dong Hwan
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GRAFT versus host disease , *AGE factors in disease , *IDIOPATHIC femoral necrosis , *HEMATOPOIETIC stem cell transplantation , *NECROSIS , *ACUTE leukemia , *OSTEONECROSIS , *HOMOGRAFTS , *CHRONIC diseases , *AGE distribution , *DISEASE incidence , *RETROSPECTIVE studies , *DISEASE complications - Abstract
Avascular necrosis (AVN) is a debilitating complication of allogeneic hematopoietic cell transplantation (HCT). A retrospective review of 845 patients who underwent HCT was conducted. Cumulative incidence of AVN was 6.3% at 4 years. The following risk factors were significantly associated with AVN risk on univariate analysis: age < 45 (p=0.004), moderate to severe chronic GvHD (p<0.001), reduced intensity conditioning (p=0.02), and a diagnosis of acute leukemia (p=0.045). Multivariate analysis confirmed two risk factors: younger age (<45 years), 9.0% vs 4.4% (p=0.011, hazard ratio (HR) 2.134), and moderate-severe chronic GvHD, 15.4% vs 2.1% (p<0.001, HR 4.950). A risk score model was generated assigning a score to each risk factor. A score of 1 was assigned to moderate-severe GvHD or those with age <45. Total score was calculated, thus dividing patient into three groups: low (score 0, n=349, 41.3%), intermediate (score 1, n=379, 44.9%), and high risk (score 2; n=116, 13.7%). This risk score could stratify the patients according to AVN risk (p<0.001). The risk of AVN was 1.5% in the low risk, 6.2% in the intermediate risk, and 20.8% in the high risk groups. Moderate-severe chronic GvHD and younger age (<45 years) are key risk factors for AVN following allogeneic HCT. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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