Aggravated bone density decline following symptomatic osteonecrosis in children with acute lymphoblastic leukemia

Abstract

ABSTRACTmay influence each other's development during treatment for pediatric ALL. Methods Study populationThis study is based on a subset of a previously described cohort. The children (4-18 years old) had newly diagnosed ALL and were treated in The Netherlands according to the Dutch Childhood Oncology Group (DCOG) -ALL9 protocol between January 1997 and November 2004.17,26 As previously described, patients were stratified into a non-high-risk treatment group and a high-risk group. 26 Briefly, high-risk criteria were: white blood cell count higher than 50×10 9

Comparing osteonecrosis clinical phenotype, timing, and risk factors in children and young adults treated for acute lymphoblastic leukemia

“…Despite the use of alternate‐week dexamethasone during delayed intensification, which has been reported to decrease development of ON, we found 28% of female adolescents developing ON within 5 years of ALL diagnosis. Age is by far the most recognized risk factor for ON, and to the best of our knowledge all studies investigating asymptomatic and/or symptomatic ON have reported older age as a risk factor . Notable, we found several patients with ON treated according to SR (n = 30), which in all likelihood is explained by age above 10 years not being a stratification parameter in the NOPHO ALL2008 protocol.…”

“…In addition, age above 10 years and presentation of ON involving multiple joints were risk factors for developing severe ON. Patients with ON in multiple joints may have more extensive ON development perhaps due to reduced BMD, which might create a vicious circle leading to further worsening of ON. Bisphosphonates can increase BMD, mainly by decreasing bone resorption, and are used to treat primary and secondary osteoporosis in pediatric patients .…”

“…Age is by far the most recognized risk factor for ON, and to the best of our knowledge all studies investigating asymptomatic and/or symptomatic ON have reported older age as a risk factor. 8,9,[12][13][14][15][16][17][18][28][29][30][31][32][33] Notable, we found several patients with ON treated according to SR (n = 30), which in all likelihood is explained by age above 10 years not being a stratification parameter in the NOPHO ALL2008 protocol.…”

MicroRNA expression and activity in T-cell acute lymphoblastic leukemia

“…Currently, intensified chemotherapy in T-ALL treatment results in a favorable overall survival for patients with 80% in children [ 15 ] and 60% in adults [ 16 ]. However, the concomitant side effects on the central nervous system and bone development should not be underestimated [ 17 ]. The prognosis of T-ALL patients with primary resistance who fail to achieve complete remission or those suffering from relapses after an initial treatment remains poor [ 18 ], with a recurrence rate of up to 20% in pediatric and 40% in adult patients [ 15 ].…”

Genetic Biomarkers to Identify the Risk of Osteonecrosis in Children with Acute Lymphoblastic Leukemia

“…It is estimated that 38-70 % [3][4][5] of patients treated for ALL develop osteonecrosis, while only 0.9-17.6 % [3,4,6] develop osteonecrosis with symptoms of pain and disability. Bone tissue has regenerating qualities to overcome osteonecrosis, and many asymptomatic or symptomatic lesions resolve spontaneously; however, it is anticipated that a considerable subset of symptomatic osteonecrosis patients will still have to cope with the disabling consequences after cessation of therapy [3,7].…”