Persistent Musculoskeletal Deficits in Pediatric, Adolescent and Young Adult Survivors of Allogeneic Hematopoietic Stem‐Cell Transplantation

• Published in: Journal of bone and mineral research 2022-04, Vol.37 (4), p.794-803
• Main Authors: Kindler, Joseph M., Guo, Michelle, Baker, Joshua, McCormack, Shana, Armenian, Saro H., Zemel, Babette S., Leonard, Mary B., Mostoufi‐Moab, Sogol
• Format: Article
• Language: English
• Subjects: Adipose tissue; Adolescent; Adult; ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION; BONE DENSITY; Bone Density - physiology; Bone mass; Cancellous bone; Child; Child, Preschool; Children; Computed tomography; Cortical bone; CORTICAL GEOMETRY; Female; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Leg; Longitudinal Studies; Male; MUSCLE CROSS‐SECTIONAL AREA; Muscle, Skeletal; MUSCULOSKELETAL DEFICITS; Pediatrics; Quality of Life; Radiation; Stem cell transplantation; Survivors; Tibia; Tibia - pathology; Young Adult
• ISSN: 0884-0431; 1523-4681
• DOI: 10.1002/jbmr.4513

ABSTRACT Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a common therapy for pediatric hematologic malignancies. With improved supportive care, addressing treatment‐related late effects is at the forefront of survivor long‐term health and quality of life. We previously demonstrated that alloHSCT survivors had increased adiposity, decreased lean mass, and lower bone density and strength, 7 years (median) from alloHSCT compared to their healthy peers. Yet it is unknown whether these deficits persist. Our longitudinal study characterized changes in muscle and bone over a period of 3.4 (range, 2.0 to 4.9) years in 47 childhood alloHSCT survivors, age 5–26 years at baseline (34% female). Tibia cortical bone geometry and volumetric density and lower leg muscle cross‐sectional area (MCSA) were assessed via peripheral quantitative computed tomography (pQCT). Anthropometric and pQCT measurements were converted to age, sex, and ancestry‐specific standard deviation scores, adjusted for leg length. Muscle‐specific force was assessed as strength relative to MCSA adjusted for leg length (strength Z‐score). Measurements were compared to a healthy reference cohort (n = 921), age 5–30 years (52% female). At baseline and follow‐up, alloHSCT survivors demonstrated lower height Z‐scores, weight Z‐scores, and leg length Z‐scores compared to the healthy reference cohort. Deficits in MCSA, trabecular volumetric bone density, and cortical bone size and estimated strength (section modulus) were evident in survivors (all p