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Pelvic Magnetic Resonance Imaging After Bone Marrow Harvest – a Retrospective Study in 50 Unrelated Marrow Donors

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Pelvic Magnetic Resonance Imaging After Bone Marrow Harvest – a Retrospective Study in 50 Unrelated Marrow Donors Bone Marrow Transplantation (2005) 35, 667–673 & 2005 Nature Publishing Group All rights reserved 0268-3369/05 $30.00 www.nature.com/bmt Pelvic magnetic resonance imaging after bone marrow harvest – a retrospective study in 50 unrelated marrow donors F Kroschinsky1, T Kittner2, S Mauersberger3, U Rautenberg3, U Schuler1, C Rutt3, M Laniado2 and G Ehninger1 1University Hospital Dresden, 1st Medical Department, Dresden, Germany; 2University Hospital Dresden, Department of Diagnostic Radiology, Dresden, Germany; and 3German Bone Marrow Donor Center (DKMS), Tuebingen, Germany Summary: hematopoietic stem cells (HSC) for transplantation from allogeneic donors. In addition to the collection of adequate A total of 50 unrelated marrow donors were examined by numbers of hematopoietic progenitors, comfort and safety pelvic magnetic resonance imaging (MRI) to investigate for the donors are of the uppermost importance, especially the morphological sequelae of bone marrow harvesting in unrelated volunteers. Several studies evaluated the risks (BMH). Signal increase in T2-weighted sequences and of marrow harvesting in larger series and demonstrated contrast media enhancement in T1 sequences at the BMH as a very safe procedure,1–5 with a reported incidence operative sites were found as typical MRI morphology 4 of major, life-threatening complications of less than 0.5%. weeks after harvest (group A, n ¼ 16), corresponding to However, a substantial number of bone marrow donors edema, hyperemia and proliferative activity. Although experience side effects resulting from general or spinal tissue repair was completed in the majority of donors 1 anesthesia, loss of oxygen-transporting erythrocytes or year after BMH, about 36% of donors in group B (n ¼ 16) operative site morbidity. Pain at the collection site or in the had abnormal findings. These included a persistence of lower back is the most frequent local problem, occurring the ‘acute injury’ signal pattern (2/16, 12%), and signal with variable severity and duration in about 70–80% of the alterations due to fatty marrow conversion (4/16, 24%). donors.3,4,6,7 Furthermore, bleedings and hematomas at The proportion of MRI abnormalities increased to over the collection site,3,8 transient compressive neuropathies,2,9 70% in two-time donors (group C, n ¼ 11), which might osteomyelitis10 as well as a fracture of the ileum11 were indicate a cumulation of tissue damage after repetitive described as rare local complications of BMH. Never- harvests. If donors had experienced prolonged discomfort theless, there is no information available about acute or after BMH (group D, n ¼ 7), MRI revealed pathological persisting morphological changes in the bone and soft signals in 86%. In conclusion, the MRI morphology tissues caused by the multiple punctures, which are needed reflects the pathophysiological reactions after BMH, to collect a sufficient volume of marrow. including inflammation and tissue repair. A further The purpose of this retrospective study was to investigate prospective evaluation in a larger number of donors is the local alterations at the operative site after a BMH necessary to confirm these results and to identify the procedure by means of magnetic resonance imaging (MRI). factors which influence the extent and duration of tissue Pelvic MRI was performed in 50 selected unrelated bone damage. marrow donors with or without postsurgical complications Bone Marrow Transplantation (2005) 35, 667–673. and/or prolonged discomfort to assess the short- and long- doi:10.1038/sj.bmt.1704873 term effects of BMH to the affected tissues. Published online 21 February 2005 Keywords: bone marrow harvest; unrelated donor; mag- netic resonance imaging Patients and methods A total of 50 adult, unrelated bone marrow donors from the German Bone Marrow Donor Center (Deutsche Bone marrow harvesting (BMH) from the posterior– Knochenmarkspenderdatei, DKMS, Tuebingen, Germany) superior iliac crest is a standard procedure to obtain were included in this MRI study. They had undergone BMH in one out of eight different German collection centers, either 4 weeks (group A, n ¼ 16) or 1 year (group B, n ¼ 16) before study entry. The donors in groups A and B Correspondence: Dr F Kroschinsky, Medizinische Klinik und were randomly selected and asked for study participation Poliklinik I, Universita¨ tsklinikum der TU Dresden, D-01307 Dresden, by the donor center. Furthermore, donors after a second Fetscherstrae 74, Germany; E-mail: [email protected] BMH (group C, n ¼ 11), and donors with a postsurgical Received 23 August 2004; accepted 13 December 2004 complication or prolonged discomfort (group D, n ¼ 7), Published online 21 February 2005 were examined. These participants were all donors with Pelvic MRI after marrow harvest F Kroschinsky et al 668 these selection criteria (two-time donor, complication) from lower limbs. Medical history and examination were the entirety of 2447 volunteers of the DKMS, who performed by a hematologist experienced in the field of underwent a BMH between May 1992 and July 2003. The marrow harvesting. protocol was approved by the Institutional Review Board MRI was performed at a 1.5 T superconductive magnet of the University Hospital Dresden, Germany. Written (Magnetom Vision, Siemens, Erlangen, Germany) using a informed consent was obtained from all participants. body phased-array coil. The study protocol included The harvests were performed between December 1994 transverse T2- (turbo inversion recovery modulus (TIRM)) and January 2003. All collection centers used common and T1-weighted (spin echo (SE)) sequences. The slice harvest procedures. Marrow had been aspirated exclusively thickness was 5 mm, with an interslice gap of 0.5 mm. In from the posterior–superior iliac crest, which was entered patients, who underwent BMH 4 weeks before MRI, through a skin puncture or a small skin incision. A slightly contrast medium (Gd-DTPA, Magnevist, Schering, Berlin, different technique was used in one of the collection Germany) was administered intravenously via an ante- centers, making 16–33 punctures or incisions in a larger cubital vein at a dosage of 0.1 mmol/kg, followed by a area above the posterior–superior iliac crests (six out of the saline flush of 20 ml. In this group, the axial T1-weighted 50 donors). During the harvests, donors were in the prone sequence was repeated after contrast medium administra- position and under general anesthesia. The volume of tion, applying a fat suppression technique. Total imaging harvested marrow per single aspiration varied from a few to time was 20 min approximately. MRI scans were assessed 20 ml. Demographic data and harvest parameters of the by two radiologists experienced in musculoskeletal diag- study population are listed in Table 1. nostics and the hematologist, who had also performed the At the time of MRI, donors were asked to describe clinical evaluation. The scans were specifically searched for postsurgical complaints, especially severity and duration bone and soft tissue injuries, sacroiliac joint (SIJ) damage, of pain, need for analgesic medication and/or limitations marrow morphology and signal alterations after applica- in normal life activities using a standardized questionnaire. tion of the contrast medium. Primary data entry was Severity of maximum pain within 48 h after the harvest performed electronically as free text using MedoraCOM was classified by the donors on a scale from 0 to 4 (0 – no software (GEHealthcare, Fairfield, USA). After comple- pain, 1 – mild, 2 – moderate, 3 – severe, 4 – very severe tion of recruitment, morphology, frequency and interpreta- pain). In a nonstandardized free interview, the donors were tion of the observed MRI findings in the different groups explored for details of BMH-related problems. Physical were evaluated systematically. Mann–Whitney test was examination included the inspection of the operative employed for the comparison of independent samples, and sites, an investigation of the mobility of the lower spinal a P-value less than 0.05 was considered as statistically column, as well as motility, sensibility and reflexes of the significant. Table 1 Characteristics of study population Group A Group B Group C Group D donors 4 weeks donors 1 year two-time donors with after harvest after harvest donors prolonged side effects Number (n)1616117 Gender (male/female) 14/2 9/7 8/3 4/3 Median age at harvest (range) (years) 31 (20–54) 32 (24–43) 31 (22–39) 35 (26–50) Body weight at harvest, mean (range) (kg) 81 (64–100) 76 (58–107) 74 (55–97) 84 (70–99) Volume of collected marrow Harvest mean (range) (ml) 1173 (580–1664) 1092 (560–1500) 845 (500–1433) 1132 (552–1400) Harvest mean (range) (ml) 805 (300–1175) Maximum pain at the collection site within 48 h after harvest,a number of donors (%) No 0 (0) 0 (0) 1 (9) 0 (0) Mild 3 (19) 1 (6) 1 (9) 0 (0) Moderate 5 (31) 5 (32) 7 (64) 2 (28) Severe 6 (37) 9 (56) 1 (9) 4 (57) Very severe 2 (13) 1 (6) 1 (9) 1 (15) Number of days after harvest with any pain Mean 12 4 5 171 Median 10 1 4 60 Range (0–30) (0–14) (0–14) (30–730) Number of days needed for complete recovery (from any complaints) Mean 16 19 13 n.r. in five donors Median 14 14 8 Range (4 – n.r.) (5–49) (2–37) aThe second harvest in two-time donors; n.r. – not reached. Bone Marrow Transplantation Pelvic MRI after marrow harvest F Kroschinsky et al 669 Results the posterior–superior spines, the adjacent muscles (gluteus maximus and gluteus minimus) and the connecting soft Group A (donors 4 weeks after BMH) tissues. After administration of contrast medium, enhance- ment was observed in the T1-weighted sequences in the All 16 donors experienced pain on the day of marrow affected area (Figure 1b). In nine cases (56%) the signal harvest and the day after the procedure. The maximum alterations affected the sacroiliac joint or crossed to the pain was described as severe or very severe in eight donors lateral mass of the sacrum, but there was no increase in (50%), while the symptoms were mild to moderate in the pain intensity or duration observed in these donors remaining donors.
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