The second patient is an 18-year-old girl who had a bone marrow relapse for ALL at 10 and had undergone an MUD BMT. Pretransplantation conditioning regimen included TBI 1200 cGy, TT, CPM, and ATG. Before BMT, corticosteroids were administered according to induction and reinduction therapy of AIEOP protocol 9502 (Methylprednisolone 211 mg/m2, Prednisone 150 mg/m2, and DXM 360 mg/m2). In addition, Prednisone was administered for one month (total dose 1950 mg/m2) to prevent an acute GVHD. After 6 months from the bone marrow infusion, she developed a limp and pain on the weight bearing joint in the right hip.
MRI examination showed a flattened right femoral head, joint effusion, enlarged physes, bone marrow oedema of the femoral neck, and minimal sclerotic changes of the articular surface. After Gadolinium IV, there was a remarkable increase of the signal on T1W sequences only in the deep portion of the femoral head (Figure 3).
A DEXA was also performed, which showed diminished bone-density, confirming the diagnosis of osteoporosis. The blood test indicated that related bony tissue turnover was normal.