Aseptic osteonecrosis in children treated for acute lymphoblastic leukemia and aplastic anemia

Prindull, G.; Weigel, Wade; Jentsch, E.; Enderlé, A.; Willert, H.‐G.

doi:10.1007/bf00442079

Cited by 38 publications

(16 citation statements)

References 20 publications

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“…In contrast there were no cases of ON with aplastic anemia treated with an antilymphocyte globulin but using a short course of low-dose steroid (20)(21)(22)(23). In the present study, ON was diagnosed in five patients with aplastic anemia before any medication was administered.…”

Section: Discussioncontrasting

confidence: 60%

“…Using MR imaging, fat conversion has been observed to occur in the proximal femoral metaphysis of steroid-treated patients and is increased in osteonecrotic hips (8,(16)(17)(18)(19). Treatment-related ON in patients with aplastic anemia has been reported in several cases (20)(21)(22)(23), but a causal relationship between aplastic anemia and ON has not yet been determined.…”

Section: Introductionmentioning

confidence: 99%

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Osteonecrosis of the Hip in Patients with Aplastic Anemia

et al. 2002

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The incidence and clinical and magnetic resonance imaging features of osteonecrosis of the hip were evaluated in patients with aplastic anemia. Two hundred and forty-one patients with aplastic anemia were examined using MR imaging of bone marrow during the five years from 1994 to 1998. Osteonecrosis of the hip was observed on MR imaging in nineteen (15 males and 4 females, mean age 35 yr) of the 241 patients. It was present in both hips in 14 patients, and there were five cases with unilateral occurrence, with a total of 33 involved hips. All except for five hips with associated bone marrow edema revealed increased fatty marrow conversion in the proximal femoral metaphysis. In nine patients, osteonecrosis was detected without any pain. Five patients already had osteonecrosis before any medication was administered. Twelve patients received antilymphocyte globulin, and seven patients received a low dose of steroids before the MR diagnosis of osteonecrosis. Osteonecrosis of the hip frequently develops in patients with aplastic anemia (7.9%), associated with fatty marrow conversion of the proximal femoral metaphysis.

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Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Osteonecrosis of the Hip in Patients with Aplastic Anemia

et al. 2002

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“…[1][2][3][4][5] Its reported frequency varies from 0% to 40%, depending on the type of therapy administered and the imaging methods employed to detect AVNB. 4,[6][7][8][9] Although the etiology of AVNB is not well understood, there is some evidence suggesting that AVNB results from ischemic insult to the bone and bone marrow. [10][11][12][13] The subsequent death of a segment of bone leads to progressive joint damage.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

Kennedy

et al. 2001

Leukemia

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The purpose of this study was to determine the frequency with which magnetic resonance (MR) imaging detects avascular necrosis of the bone (AVNB) in children with acute lymphoblastic leukemia (ALL) or advanced-stage non-Hodgkin lymphoma (NHL) who receive prednisone during remission induction, reinduction, and maintenance chemotherapy; to assess the clinical significance of these findings; and to identify factors predictive of AVNB. We prospectively obtained MR imaging of the hips and knees of 116 children who had completed at least 1 year of treatment for ALL or advanced-stage NHL on identical prednisone-containing regimens between December 1991 and October 1994. MR imaging findings of AVNB were compared with clinical outcomes, and the effect of therapeutic and patient factors on the frequency of AVNB was analyzed. The MR imaging findings of 17 of the 116 participating patients were consistent with AVNB. The most common clinical manifestation was joint pain (11 patients). Only one patient had progressive joint deterioration that necessitated surgical replacement. Only age 10 years or more at the time of the primary diagnosis was significantly associated with the development of AVNB (P = 0.004). MR imaging showed changes consistent with AVNB in approximately 15% of this patient population. However, most patients in this study who had MR imaging signs of AVNB did not experience progressive joint destruction, even with continued prednisone therapy. Therefore, the clinical usefulness of MR imaging as a screening tool for AVNB in this set of patients remains uncertain. Leukemia (2001) 15, 891-897.

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“…Osteonecrosis may occur as a complication of several disorders [1]. Most of the reports on children with malignancies and osteonecroses suggest corticosteroids to be the main pathogenetic factor [2][3][4][5]. However, the role of other cytostatic drugs has been discussed in the reports on cases on which osteonecrosis has developed in relation to chemotherapy protocols not containing steroids [6][7][8][9], and the synergistic effect of chemotherapy, radiotherapy, and corticosteroids has been also speculated [10].…”

Section: Introductionmentioning

confidence: 99%

Osteonecrosis during the treatment of childhood acute lymphoblastic leukemia: A prospective MRI study

Pääkkö

et al. 1999

Med. Pediatr. Oncol.

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Aseptic osteonecrosis in children treated for acute lymphoblastic leukemia and aplastic anemia

Cited by 38 publications

References 20 publications

Osteonecrosis of the Hip in Patients with Aplastic Anemia

Osteonecrosis of the Hip in Patients with Aplastic Anemia

Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

Osteonecrosis during the treatment of childhood acute lymphoblastic leukemia: A prospective MRI study

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