IBMS BoneKEy | Clinical Cases
Denosumab increases bone mineral density in a young osteoporotic woman on dialysis after allogeneic stem cell transplantation for hematologic malignancy
Xerxes Pundole
Kebriaei Partow
Huifang Lu
DOI:10.1038/bonekey.2014.58
Abstract
Osteoporosis is a common, long-term skeletal complication of allogeneic stem cell transplantation (allo-SCT). Osteoporosis can lead to increased bone fragility and an increased risk of fractures. Several treatment modalities are currently available to prevent and treat bone loss in patients undergoing allo-SCT, but with some limitations. Bisphosphonates are useful antiresorptive agents used to treat bone loss, but their use in patients with renal impairment is limited. Denosumab, a humanized monoclonal antibody to receptor activator factor-kappa B ligand, might be a therapeutic option for osteoporosis in patients with renal impairment after allo-SCT but has not been well studied in such patients. We present here the case of a young woman who was on dialysis due to renal failure after allo-SCT for acute myeloid leukemia and whose severe osteoporosis was safely and successfully treated with denosumab. To our knowledge, we are the first to report the benefit of denosumab in a patient who underwent allo-SCT and who also had severe renal impairment and was undergoing dialysis. The rapid onset of action, sustained long-term effects and good tolerability of denosumab suggest that this drug should be evaluated in future studies of patients with hematologic malignancies who have renal insufficiency and osteoporosis after allo-SCT.
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