The first patient, now 20 years old, had originally been diagnosed with anaplastic Large Cell Lymphoma when he was 12 and received corticosteroid therapy according to the AIEOP NHL 92 protocol, Dexamethasone (DXM) 448mg/m2 until relapse and DXM 420 mg/m2 from the first relapse to the pretransplantation conditioning regimen. After 4 relapses, he underwent matched unrelated donor (MUD) transplantation. The conditioning regimen was TBI (1200 cGy), Thiotepa (TT), Ciclophosphamide (CPM), and Antithymocyte globulin (ATG).
A six-month treatment with corticosteroids (Methylprednisolone 8975 mg/m2, Prednisone 10500 mg/m2, and Hydrocortisone 2710 mg/m2) was used for grade IV acute and severe chronic GVHD of gut, skin, and lungs. Eight months after BMT, while still under corticosteroid therapy, he developed a limp and severe pain in the left hip. An MRI was performed (Figure 1) and revealed a moderate joint effusion, as well as fat-like aspects of osteonecrosis involving the weight bearing portion of the femoral heads particularly extruded in the left hip where the articular surface was partially flattened. Bone marrow oedema was also present bilaterally around the right femoral capital necrosis (Figure 1). A DEXA was performed, which showed osteoporosis. The blood test indicated that related bony tissue turnover was normal.