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With improved supportive care, addressing treatment-related late effects is at the forefront of survivor long-term health and quality of life. We previously demonstrated that alloHSCT survivors had increased adiposity, decreased lean mass, and lower bone density and strength, 7\u2009years (median) from alloHSCT compared to their healthy peers. Yet it is unknown whether these deficits persist. Our longitudinal study characterized changes in muscle and bone over a period of 3.4 (range, 2.0 to 4.9) years in 47 childhood alloHSCT survivors, age 5\u201326\u2009years at baseline (34% female). Tibia cortical bone geometry and volumetric density and lower leg muscle cross-sectional area (MCSA) were assessed via peripheral quantitative computed tomography (pQCT). Anthropometric and pQCT measurements were converted to age, sex, and ancestry-specific standard deviation scores, adjusted for leg length. Muscle-specific force was assessed as strength relative to MCSA adjusted for leg length (strength Z-score). Measurements were compared to a healthy reference cohort (n\u00a0=\u00a0921), age 5\u201330\u2009years (52% female). At baseline and follow-up, alloHSCT survivors demonstrated lower height Z-scores, weight Z-scores, and leg length Z-scores compared to the healthy reference cohort. Deficits in MCSA, trabecular volumetric bone density, and cortical bone size and estimated strength (section modulus) were evident in survivors (all p\u2009&amp;lt;\u20090.05). Between the two study time points, anthropometric, muscle, and bone Z-scores did not change significantly in alloHSCT survivors. Approximately 15% and 17% of alloHSCT survivors had MCSA and section modulus Z-score\u2009&amp;lt;\u2009\u22122.0, at baseline and follow-up, respectively. Furthermore, those with a history of total body irradiation compared to those without demonstrated lower MCSA at follow-up. The persistent muscle and bone deficits in pediatric alloHSCT survivors support the need for strategies to improve bone and muscle health in this at-risk population. \u00a9 2022 American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4513","type":"journal-article","created":{"date-parts":[[2022,1,26]],"date-time":"2022-01-26T01:54:52Z","timestamp":1643162092000},"page":"794-803","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Persistent Musculoskeletal Deficits in Pediatric, Adolescent and Young Adult Survivors of Allogeneic Hematopoietic Stem-Cell Transplantation"],"prefix":"10.1093","volume":"37","author":[{"given":"Joseph M.","family":"Kindler","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Children's Hospital of Philadelphia Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4633-3997","authenticated-orcid":false,"given":"Michelle","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Pennsylvania Perelman School of Medicine Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Baker","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine University of Pennsylvania Philadelphia PA USA"},{"name":"Corporal Michael J. Crescenz VA Medical Center Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shana","family":"McCormack","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Children's Hospital of Philadelphia Philadelphia PA USA"},{"name":"Department of Pediatrics University of Pennsylvania Perelman School of Medicine Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saro H.","family":"Armenian","sequence":"additional","affiliation":[{"name":"Department of Population Sciences City of Hope Duarte CA USA"},{"name":"Department of Pediatrics City of Hope Duarte CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6164-7348","authenticated-orcid":false,"given":"Babette S.","family":"Zemel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Pennsylvania Perelman School of Medicine Philadelphia PA USA"},{"name":"Division of Gastroenterology, Hepatology and Nutrition Children's Hospital of Philadelphia Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary B.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8623-1138","authenticated-orcid":false,"given":"Sogol","family":"Mostoufi-Moab","sequence":"additional","affiliation":[{"name":"Division of Oncology Children's Hospital of Philadelphia Philadelphia PA USA"},{"name":"Division of Endocrinology Children's Hospital of Philadelphia Philadelphia PA USA"},{"name":"Department of Pediatrics University of Pennsylvania Perelman School of Medicine Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,1,25]]},"reference":[{"issue":"9","key":"2024012714020672100_jbmr4513-bib-0001","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1002\/pbc.24559","article-title":"Transplant-related mortality following allogeneic hematopoeitic stem cell transplantation for pediatric acute lymphoblastic leukemia: 25-year retrospective review","volume":"60","author":"Mateos","year":"2013","journal-title":"Pediatr Blood Cancer"},{"issue":"20","key":"2024012714020672100_jbmr4513-bib-0002","doi-asserted-by":"crossref","first-page":"3754","DOI":"10.1200\/JCO.2003.03.133","article-title":"Trends in survival rates after allogeneic hematopoietic stem-cell transplantation for acute and chronic leukemia by ethnicity in the United States and Canada","volume":"21","author":"Serna","year":"2003","journal-title":"J Clin Oncol"},{"issue":"3","key":"2024012714020672100_jbmr4513-bib-0003","doi-asserted-by":"crossref","first-page":"e13158","DOI":"10.1111\/petr.13158","article-title":"Transplant-related mortality and survival in children with malignancies treated with allogeneic hematopoietic stem cell transplantation. A multicenter analysis","volume":"22","author":"Zaucha-Prazmo","year":"2018","journal-title":"Pediatr Transplant"},{"issue":"10","key":"2024012714020672100_jbmr4513-bib-0004","doi-asserted-by":"crossref","first-page":"e0204914","DOI":"10.1371\/journal.pone.0204914","article-title":"Early and late complications following hematopoietic stem cell transplantation in pediatric patients - a retrospective analysis over 11\u2009years","volume":"13","author":"Hierlmeier","year":"2018","journal-title":"PLoS One"},{"issue":"11","key":"2024012714020672100_jbmr4513-bib-0005","doi-asserted-by":"crossref","first-page":"e573","DOI":"10.1016\/S2352-3026(19)30158-9","article-title":"Outcomes of allogeneic haematopoietic stem cell transplantation from HLA-matched and alternative donors: a European Society for Blood and Marrow Transplantation registry retrospective analysis","volume":"6","author":"Shouval","year":"2019","journal-title":"Lancet 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