{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:49:15Z","timestamp":1790660955665,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2003,4,30]],"date-time":"2003-04-30T00:00:00Z","timestamp":1051660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Ministero dell'Universit\u00e0 e della Ricerca Scientifica e Tecnologica (MURST)"},{"DOI":"10.13039\/501100004462","name":"Consiglio Nazionale delle Ricerche (CNR)","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004462","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2003,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>The most debilitating skeletal complication of stem cell transplantation (SCT) is avascular necrosis (AVN).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Two hundred seven consecutive patients were evaluated prospectively for AVN. They survived disease free for more than 180 days after autologous or allogeneic SCT for hematologic malignancies. The diagnosis of AVN in suspicious cases was confirmed by magnetic resonance imaging. Possible correlations with treatments, bone mineral density (BMD), graft versus host disease (GVHD), and in vitro growth of fibroblast progenitors were investigated. Bone mineral density was evaluated by dual\u2010energy X\u2010ray absorptiometry in 100 transplanted patients, and the in vitro growth of fibroblast progenitors was monitored by a fibroblast colony\u2010forming unit (CFU\u2010F) assay in 30 patients after allogeneic SCT.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Twelve patients developed AVN 3\u2013114 months (median, 26 months) following SCT: 10 (10%) after allogeneic SCT and 2 (1.9%) after autologous SCT (<jats:italic>P<\/jats:italic> = 0.04). Twenty\u2010five joints were affected by AVN. All patients had femoral head involvement, which was managed with hip replacement in six of them. All but one patient who developed AVN after allogeneic SCT suffered from chronic GVHD (cGVHD). Avascular necrosis occurred 1\u20134 months after exacerbation or progression of cGVHD. Cumulative dose of steroids was similar in both SCT groups (including steroids given pretransplant for the basic disease), whereas treatment duration was significantly longer in the allogeneic SCT group. Avascular necrosis was related to the decreased number of bone marrow CFU\u2010F colonies in vitro, but not to BMD values.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Avascular necrosis is a skeletal complication that occurs more often after allogeneic than after autologous SCT. Occurrence of AVN symptoms after clinical follow\u2010up of cGVHD suggests that cGVHD requiring long\u2010term steroid therapy is one of the main risk factors for AVN. Avascular necrosis may be facilitated by a severe deficit in the repopulating capacity of bone marrow stromal stem cells after SCT. Cancer 2003;97:2453\u201361. \u00a9 2003 American Cancer Society.<\/jats:p><jats:p>DOI 10.1002\/cncr.11373<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.11373","type":"journal-article","created":{"date-parts":[[2003,4,30]],"date-time":"2003-04-30T22:01:10Z","timestamp":1051740070000},"page":"2453-2461","source":"Crossref","is-referenced-by-count":98,"title":["Avascular necrosis in long\u2010term survivors after allogeneic or autologous stem cell transplantation"],"prefix":"10.1002","volume":"97","author":[{"given":"Libuse","family":"Tauchmanov\u00e0","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"De Rosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Serio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Fazioli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Mainolfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Lombardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria","family":"Colao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Salvatore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Rotoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Selleri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2003,4,30]]},"reference":[{"key":"e_1_2_6_2_2","first-page":"66","article-title":"Avascular necrosis of bone in patients undergoing renal allotransplantation","volume":"5","author":"Bewick M","year":"1976","journal-title":"Clin Nephrol."},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197602122940718"},{"key":"e_1_2_6_4_2","first-page":"421","article-title":"Avascular necrosis of the femoral head secondary to corticosteroid therapy for graft\u2010versus\u2010host disease after marrow transplantation: effective therapy with hip arthroplasty","volume":"2","author":"Atkinson K","year":"1987","journal-title":"Bone Marrow Transplant."},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199503000-00018"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-0172(05)80026-5"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199205283262206"},{"key":"e_1_2_6_8_2","first-page":"153","article-title":"Aseptic bone necrosis in patients on glucocorticoid replacement therapy","volume":"39","author":"Vreden SG","year":"1991","journal-title":"Neth J Med."},{"key":"e_1_2_6_9_2","first-page":"339","volume-title":"Bone marrow transplantation","author":"Sullivan KM","year":"1994"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-020800"},{"key":"e_1_2_6_11_2","first-page":"2","article-title":"Editorial comment on fifth international symposium on bone circulation","volume":"334","author":"Stulberg BN","year":"1997","journal-title":"Clin Orthop."},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003072-198401000-00015"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(90)90214-X"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1994.tb04795.x"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.1997.1262940.x"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(97)00219-6"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19910801)68:3<655::AID-CNCR2820680336>3.0.CO;2-V"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1701374"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.1999.14.3.342"},{"key":"e_1_2_6_20_2","first-page":"47.1","volume-title":"Rheumatology","author":"Mazi\u00e8res B","year":"1994"},{"key":"e_1_2_6_21_2","first-page":"9","article-title":"Idiopathic osteonecrosis of the femoral head. 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