Premium
Avascular necrosis after treatment of aplastic anaemia with antilymphocyte globulin and high‐dose methylprednisolone
Author(s) -
Marsh J. C. W.,
Zomas A.,
Hows J. M.,
Chapple M.,
GordonSmith E. C.
Publication year - 1993
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1993.tb03153.x
Subject(s) - medicine , avascular necrosis , prednisolone , surgery , methylprednisolone , regimen , incidence (geometry) , cumulative incidence , aplastic anemia , bone marrow , transplantation , femoral head , physics , optics
Summary. 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 indentical 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.