title: Avascular necrosis after treatment of aplastic anaemia with antilymphocyte globulin and high-dose methylprednisolone.
abstract: Avascular necrosis of bone (AVN) occurring in patients with aplastic anaemia (AA) treated with antilymphocyte globulin (ALG) followed by high-dose methylprednisolone (HDMP) has been studied retrospectively. Out of 49 patients treated at two centres, seven have developed AVN at a median of 14 months (range 6-30) following treatment. The cumulative incidence of AVN is 21% (95% confidence intervals 7-35%). The hip was involved in six patients, bilaterally in five. Two patients had more than two joints affected. Surgical intervention was necessary in five patients, three of whom required total hip replacement. In contrast, there were no cases of AVN in a historical group of 61 patients with aplastic anaemia treated with an identical regimen of ALG but using a short course of low-dose prednisolone. Lack of convincing evidence for benefit, the considerable morbidity from AVN, and increased risk of early life-threatening infection, suggest that high-dose methyl prednisolone should be omitted from ALG treatment protocols for aplastic anaemia.
authors.affiliation: Department of Haematology, St George's Hospital Medical School, Tooting, London.
authors.forename: J C
authors.initials: JC
authors.lastname: Marsh
authors.forename: A
authors.initials: A
authors.lastname: Zomas
authors.forename: J M
authors.initials: JM
authors.lastname: Hows
authors.forename: M
authors.initials: M
authors.lastname: Chapple
authors.forename: E C
authors.initials: EC
authors.lastname: Gordon-Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000628:therapy*; D000961:Antilymphocyte Serum / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced*; D011239:Prednisolone / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D000961:Antilymphocyte Serum; D011239:Prednisolone; D008775:Methylprednisolone