AVASCULAR NECROSIS BONE IN CHRONIC GRAFT-VERSUS-HOST DISEASE POST-ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION

M. Ibáñez Martínez, S. Pastor Navarro, B. Miguel Ibáñez, C. C. Chacón Vélez, A. I. Turrión Nieves, O. Martínez González, S. Gómez Castro, C. Montila Morales, C. Hidalgo CallejaSalamanca University Hospital, Rheumatology, Salamanca, Spain  Background Graft-versus-host disease (GVHD) is the most frequent complication after allogeneic hematopoietic cell transplantation (allo-HCT). The first line of treatment for moderate-severe chronic GVHD (cGVHD) is usually high and prolonged doses of corticosteroid therapy. Avascular necrosis bone (AVN) is a complication that appears after allo-HCT with an incidence of 5% to 19%. The exact mechanism by which it occurs is unkown and probably multifactorial. However, it has been associated with the presence and treatment of cGVHD. Objectives To describe the prevalence of AVN and its clinical characteristics in a cohort of patients with cGVHD evaluated in a multidisciplinary practice. Methods Descriptive and prospective observational study to describe the prevalence and characterization of AVN in a cohort of 132 patients with steroid-refractory cGVHD in multidisciplinary consultation. Variables related to baseline disease, transplantation and clinical manifestations of cGVHC are collected. Results 14 (10,6%) developed AVN confirmed by magnetic resonance imaging. The transplant-related characteristics and clinical features of cGVHD are detailed in Table 1. All of them had been receiving steroids. The average time from transplantation to AVN was 2,5 years (0-5,5). The mean age of AVN diagnosis was 46 years (range 17-65). Three patients had developed the AVN before the first visit.The diagnosis of AVN was during follow-up in the rest of them, with a mean onset of 23 months (1-48). 64,3% had more than one joint affected. The head of femur was the most commonly affected area (64,3%), followed by knee (35,7%). Other sites also affected were elbow, humeral head and ankle, with one case each. 64,3% needed joint replacement. Conclusion AVN in our cohort is a relatively common complication and it occurs in moderate-severe cGVHD. These patients present pain and limitation in range of motion and these manifestations may also appear in the context of GVHD itself. Early recognition is a challenge to avoid misdiagnosis and the risk of overtreatment with steroids that would increase the progression of the lesion. References Law AD et al. Moderate-severe grade of chronic graft versus host disease and younger age (less than 45 years old) are risk factors for avascular necrosis in adult patients undergoing allogeneic hematopoietic cell transplantation. Ann Hematol. 2021 May;100(5):1311-1319. Bar M et al. Bone Health Management After Hematopoietic Cell Transplantation: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant. 2020 Oct;26(10):1784-1802. Table 1. BASELINE, TRANSPLANT-RELATED CHARACTERISTICS AND CLINICAL FEATURES OF CGVHD Variables N (%)/ mean (range) Total 14 Age of transplantation,years 43 (16-61) Gender (male/famale) 10 (71,4%)/4 (28,6%) Body mass index 23,8 (17,3-41,1) Diagnosis - ALL/MDS/AML 5(35,7%)/3(21,4%)/2 (14,3%) - CLL/NHL/MPS/BTM 1/1/1/1 (7,1%) HCT type - Related (haploidentical) 7 (50%) (1; 7,1%) - Unrelated 7 (50%) Conditioning regimen: - Myeloablative 9 (64,3%) - Reduced-intensity 5 (35,7%) Stem cell graft source - Peripheral blood 12 (85,7%) - Bone marrow/umbilical cord 1/1 (7,1%) Time from allo-HCT to enrollment, months 18 (4-46) Involvement site - ECOG: 1/2/3 6 (42,9%)/ 4(28,6%)/ 1 (7,1%) - Mouth 8 (57,1%) - Eye 8 (57,1%) - Genital tract 2 (14,2%) - Gastroinestinal 4 (28,6%) - Liver 1 (7,1%) - Lung 4 (28,6%) - BSA: mild/moderate/severe 3/3/3 (21,4%) - ROM: mild/moderate/severe 6 (42,9%)/5 (35,7%)/1 (7,1%) Clinical forms cGVHD: - Sclerotic 9 (64,3%) - Joint 3 (21,4%) - Lichenoid 1 (7,1%) - Psoriasiform 1 (7,1%) NIH global score - Mild/moderate/severe 1 (7,1%)/4 (28,6%)/9 (64,3%) Acute lymphoblastic leukemia, Myelodysplasic syndrome; Acute myeloid leukemia, Chronic lymphocytic leukemia, Non-Hodking’s lymphoma, Myeloproliferative syndrome, Beta-thalassemia major; Eastern Cooperative Oncology Group Perfomance Status; Body Surface area; Range Of Mobility; National Institutes of Health Acknowledgements: NIL. Disclosure of Interests None Declared. Keywords: Pain, Bone diseases DOI: 10.1136/annrheumdis-2023-eular.4386Citation: , volume 82, supplement 1, year 2023, page 1959Session: Other orphan diseases (Publication only)