title: Adverse Fat Depots and Marrow Adiposity Are Associated With Skeletal Deficits and Insulin Resistance in Long-Term Survivors of Pediatric Hematopoietic Stem Cell Transplantation.
abstract: Allogeneic hematopoietic stem-cell transplantation (alloHSCT) survivors treated with total body irradiation (TBI) exhibit bone deficits and excess adiposity, potentially related to altered mesenchymal stem cell differentiation into osteoblasts or adipocytes. We examined associations among fat distribution, bone microarchitecture, and insulin resistance in alloHSCT survivors after TBI. This was a cross-sectional observational study of 25 alloHSCT survivors (aged 12 to 25 years) a median of 9.7 (4.3 to 19.3) years after alloHSCT compared to 25 age-, race-, and sex-matched healthy controls. Vertebral MR spectroscopic imaging and tibia micro-MRI were used to quantify marrow adipose tissue (MAT) and trabecular microarchitecture. Additional measures included DXA whole-body fat mass (WB-FM), leg lean mass (Leg-LM), trunk visceral adipose tissue (VAT), and CT calf muscle density. Insulin resistance in alloHSCT survivors was estimated by HOMA-IR. AlloHSCT survivors had lower Leg-LM (p < 0.001) and greater VAT (p < 0.01), MAT (p < 0.001), and fat infiltration of muscle (p = 0.04) independent of WB-FM, versus matched controls; BMI did not differ. Survivors had lower bone volume fraction and abnormal microarchitecture including greater erosion and more rod-like structure versus controls (all p = 0.04); 14 had vertebral deformities and two had compression fractures. Greater WB-FM, VAT, MAT, and muscle fat infiltration were associated with abnormal trabecular microarchitecture (p < 0.04 for all). AlloHSCT HOMA-IR was elevated, associated with younger age at transplantation (p < 0.01), and positively correlated with WB-FM and VAT (both p < 0.01). In conclusion, the markedly increased marrow adiposity, abnormal bone microarchitecture, and abnormal fat distribution highlight the risks of long-term treatment-related morbidity and mortality in alloHSCT recipients after TBI. Trabecular deterioration was associated with marrow and visceral adiposity. Furthermore, long-term survivors demonstrated sarcopenic obesity, insulin resistance, and vertebral deformities. Future studies are needed to identify strategies to prevent and treat metabolic and skeletal complications in this growing population of childhood alloHSCT survivors.
authors: Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Sogol
authors: S
authors: Mostoufi-Moab
authors: Department of Radiology, Hospital of University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Jeremy
authors: J
authors: Magland
authors: Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Elizabeth J
authors: EJ
authors: Isaacoff
authors: Department of Radiology, Hospital of University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Wenli
authors: W
authors: Sun
authors: Department of Radiology, Hospital of University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Chamith S
authors: CS
authors: Rajapakse
authors: Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Babette
authors: B
authors: Zemel
authors: Department of Radiology, Hospital of University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Felix
authors: F
authors: Wehrli
authors: Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Karuna
authors: K
authors: Shekdar
authors: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Joshua
authors: J
authors: Baker
authors: Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Jin
authors: J
authors: Long
authors: Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Mary B
authors: MB
authors: Leonard
mesh_terms: D017667:Adipocytes / Q000166:cytology; D050154:Adiposity; D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D001794:Blood Pressure; D015992:Body Mass Index; D001853:Bone Marrow / Q000473:pathology; D001842:Bone and Bones / Q000473:pathology*; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D010006:Osteoblasts / Q000166:cytology; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology; D017741:Survivors; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology; D055815:Young Adult
keywords: HEMATOPOIETIC STEM CELL TRANSPLANTATION; MARROW ADIPOSITY; TRABECULAR MICROARCHITECTURE; VERTEBRAL FRACTURE; VISCERAL ADIPOSE TISSUE