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Title: An individualised risk-adapted protocol of pre- and post transplant zoledronic acid reduces bone loss after allogeneic stem cell transplantation: results of a phase II prospective trial
Austin Authors: Grigg, Andrew P ;Butcher, B;Khodr, B;Bajel, A;Hertzberg, M;Patil, S;D'Souza, A B;Ganly, P;Ebeling, P;Wong, E ;Australasian Leukaemia and Lymphoma Group (ALLG)
Affiliation: Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia
University of Melbourne, Melbourne, Victoria, Australia
WriteSource Medical Pty Ltd, Lane Cove, NSW, Australia
Australasian Leukaemia and Lymphoma Group, Richmond, Victoria, Australia
Bone Marrow Transplant Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Haematology, Prince of Wales Hospital, Sydney, NSW, Australia
Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
Wellington Hospital, Wellington, New Zealand
Christchurch Hospital, Christchurch, New Zealand
Monash University, Clayton, Victoria, Australia
Issue Date: Sep-2017 2017-06-19
Publication information: Bone Marrow Transplantation 2017; 52(9): 1288-1293
Abstract: Bone loss occurs frequently following allogeneic haematopoietic stem cell transplantation (alloSCT). The Australasian Leukaemia and Lymphoma Group conducted a prospective phase II study of pretransplant zoledronic acid (ZA) and individualised post-transplant ZA to prevent bone loss in alloSCT recipients. Patients received ZA 4 mg before conditioning. Administration of post-transplant ZA from days 100 to 365 post alloSCT was determined by a risk-adapted algorithm based on serial bone density assessments and glucocorticoid exposure. Of 82 patients enrolled, 70 were alive and without relapse at day 100. A single pretransplant dose of ZA prevented femoral neck bone loss at day 100 compared with baseline (mean change -2.6±4.6%). Using the risk-adapted protocol, 42 patients received ZA between days 100 and 365 post alloSCT, and this minimised bone loss at day 365 compared with pretransplant levels (mean change -2.9±5.3%). Femoral neck bone loss was significantly reduced in ZA-treated patients compared with historical untreated controls at days 100 and 365. This study demonstrates that a single dose of ZA pre-alloSCT prevents femoral neck bone loss at day 100 post alloSCT, and that a risk-adapted algorithm is able to guide ZA administration from days 100 to 365 post transplant and minimise further bone loss.
DOI: 10.1038/bmt.2017.108
Journal: Bone Marrow Transplantation
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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