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Marked Increase in Fracture Risk in Patients Receiving Hematopoietic Stem Cell Transplantation

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Key Points

  • Factors associated with increased fracture risk were age, underlying disease, and hematopoietic stem cell transplantation type.
  • Fracture risk was particularly elevated in patients aged 45 to 64 years at hematopoietic stem cell transplantation.

In a single-institution retrospective study reported in the Journal of Clinical Oncology, Pundole et al found that patients undergoing hematopoietic stem cell transplantation are at increased risk of bone fracture later in life, with risk being particularly elevated in women and men aged 45 to 64 years.

Study Details

The study involved data from 7,620 patients aged > 18 years who underwent hematopoietic stem cell transplantation at The University of Texas MD Anderson Cancer Center from January 1997 to December 2011 and were followed through December 2013. Cumulative incidence of fracture was calculated with death as a competing risk. Age- and sex-specific fracture incidence rates per person-years were compared with those in the U.S. general population using estimated rates from the 1994 National Health Interview Survey and the 2004 National Hospital Discharge Survey.

Of 7,620 patients who underwent hematopoietic stem cell transplantation, 51% underwent autologous and 49% allogeneic stem cell transplantation, 56% were male, and 75% were white. The most common reasons for hematopoietic stem cell transplantation were hematologic malignancy other than multiple myeloma (67%) and multiple myeloma (22%); other reasons included primary solid tumors in 11% (46% breast and 27% ovarian cancer).

Fracture Risk

Median follow-up was 85 months. Fracture occurred in 8% of patients (n = 602), including 11% of those with autologous stem cell transplantation and 5% of those with allogeneic stem cell transplantation. More than 50% of patients died before experiencing a fracture and 39% were censored at the end of the follow-up.

On multivariate analysis, age at time of hematopoietic stem cell transplantation (hazard ratio [HR] = 1.94, P < .001 for > 50 vs ≤ 50 years), underlying disease (HRs = 6.50, P < .001, for multiple myeloma and 1.79, P < .001, for solid tumors/other vs hematologic malignancy other than multiple myeloma), and hematopoietic stem cell transplantation type (HR  = 2.09, P < .001, for autologous vs allogeneic) were significantly associated with fracture risk.

Age- and sex-specific fracture incidence rates after hematopoietic stem cell transplantation were significantly greater than those in the U.S. general population in almost all subgroups. Compared with National Health Interview Survey data, estimated relative risks (RRs) for age at hematopoietic stem cell transplantation of 18 to 24, 25 to 44, 45 to 64, and 65 to 69 years were 2.1, 3.5, 8.0, and 7.7 among women and 0.8, 1.6, 9.0, and 13.1 among men.

Compared with National Hospital Discharge Survey data, RRs for these age groups were 3.0, 7.7, 8.0, and 2.9 among women and 1.8, 3.2, 6.6, and 6.5 among men.

The investigators concluded: “The incidence of fractures is compellingly higher after [hematopoietic stem cell transplantation].”

Huifang Lu, MD, PhD, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

Richard E. Champlin, MD, reported a consulting or advisory role with Takeda Pharmaceuticals, Celgene, Amgen, Alexion Pharmaceuticals, AiCuris, and Actinium Pharmaceuticals.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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