Bone mass deficits in children with leukemia following hematopoietic stem cell transplantation (HSCT) are multifactorial.
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Attention is needed for children with less potential to recover from low bone mineral density.
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Risk factors for osteonecrosis (ON) include older age at HSCT, steroids, chronic graft-versus-host disease, and prior ON.
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Management of ON in children with acute lymphoblastic leukemia following HSCT remains challenging.
ABSTRACT
Allogeneic hematopoietic stem cell transplantation (HSCT) is widely performed in children and adolescents with hematologic diseases, including very high-risk leukemia. With increasing success and survival rates, the long-term sequelae of HSCT have become important. Here, we provide guidance to the prevention and treatment of the most common bone morbidities—osteoporosis and osteonecrosis—emerging in the context of HSCT in children and adolescents. We give an overview on definitions, symptoms, and diagnostics and propose an algorithm for clinical practice based on discussions within the International Berlin Frankfurt Münster (BFM) Stem Cell Transplantation Committee and the Pediatric Disease Working Party of the European Society for Blood and Marrow Transplantation, our expert knowledge, and a literature review.
Keywords
Bone morbidity
Children and adolescents
Allogeneic HSCT
Leukemia
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Financial disclosure: See Acknowledgments on page e33.