Musculoskeletal
Bone Marrow Transplant
Survivors of BMT can have multiple musculoskeletal late effects:
Reduced growth:
- Skeleton and all MSK structures in young children have reduced growth after low dose whole body radiation therapy (Total body Irradiation or TBI)
- Effect is more severe the younger the child is and the greater the potential for growth
Osteoporosis:
Multiple factors lead to early onset and more severe osteoporosis in survivors of BMT:
- Disease itself:
- Leukemic infiltration of the bone damages the spongiosa structure
- Significantly reduced bone density found in patients prior to BMT
- Various factors secreted by leukemic cells, such as ectopic production of parathyroid hormone (PTH) or PTH-related peptide, and paracrine secretion of lymphokines
- Result is:
- Reduced production of growth factors
- Osteoclast activation by increased cytokine release
- Decreased number and function of osteoblast precursors within the stromal stem cell compartment
- Therapy:
- Whole body radiation therapy (TBI)
- Intensive chemotherapy
- Other medications:
- Corticosteroids
- affect bone directly
- alter hormonal axes
- corticosteroids reduce intestinal calcium absorption and increase renal calcium excretion
- Other factors:
- Inactivity
- Dietary deficiencies
- Hypogonadism
Both oral and parenteral bisphosphonates have beneficial effects on osteoporosis in BMT long-term survivors.
Secondary neoplasms:
- Benign
- Malignant
- Rare
- Bone sarcomas
- Rare
Chronic arthritis and joint deformity secondary to cGvHD:
