Clinical and Prognostic Implications of Bone Lesions in Childhood Leukemia at Diagnosis

Abstract

We studied 168 children with acute lymphoblastic leukemia (ALL) and 57 with acute nonlymphoblastic leukemia (ANLL) by retrospectively analyzing clinical symptoms, bone or joint involvement, and hematological findings to verify the clinical features and prognosis of children with acute leukemia who showed radiographic bone changes at the time of diagnosis. Of these, 36 with ALL (21.4%) and 6 with ANLL (10.5%) had symptoms referable to the bones or joints. Thirteen patients (7.7%) with ALL showed bone lesions radiographically. Phenotypically, 12 of the 13 had common ALL, 8 were incorrectly diagnosed and had received treatment for osteomyelitis or juvenile rheumatoid arthritis for 1 to 7 months prior to diagnosis of ALL. Leukocyte count was nearly normal with few or no blasts, and anemia and thrombocytopenia were mild or absent in all patients. Twelve of them remained in a complete remission for 26 to 148 months. Our data suggest that children with bone lesions related to acute leukemia exhibit clinical features that mimic infectious or collagen disease at diagnosis, and may belong to a subgroup of ALL with a better prognosis.

Acute lymphocytic leukemia in adolescence with multiple osteolytic lesions and hypercalcemia mediated by lymphoblast‐producing parathyroid hormone‐related peptide: A case report and review of the literature

“…There have been only a small number of case reports in which various hypercalcemia‐associated factors were examined, and the prognoses have also been described in few reports (Table 2). In the past, some researchers have suggested that bone lesions at the initial presentation of childhood ALL are associated with good prognosis 33,34, and another retrospective report suggested that bone involvement had no association with the prognosis 35. In the above‐mentioned study on four cases of hypercalcemia from a single institute, no association was found between hypercalcemia and prognosis 30.…”

Skeletal morbidity in childhood acute lymphoblastic leukaemia

“…6 There are conflicting reports as to whether skeletal involvement at diagnosis has an influence on prognosis. [7][8][9] Bone metabolism at diagnosis…”

“…6 There are conflicting reports as to whether skeletal involvement at diagnosis has an influence on prognosis. [7][8][9] Bone metabolism at diagnosis At diagnosis, serum markers of bone formation, procollagen type I C-terminal propeptide (PICP) and bone alkaline phosphatase (AP), are significantly lower than expected. 10,11 Low concentrations of the bone collagen degradation peptide, carboxyterminal telopeptide of type I collagen (ICTP), have also been demonstrated.…”

CD45(-) Acute Lymphoblastic Leukemia Characterized by Migratory Arthritis, Thrombocytosis, Thrombosis and Early Relapse: Case Report and Literature Review

“…Bone or joint pain can be one of the presenting symptoms in leukemic children. Patients may be incorrectly diagnosed and treated for osteomyelitis or juvenile inflammatory arthritis several months prior to ALL diagnosis [2]. Additionally, osteomyelitis itself is a known presenting symptom and complication of ALL [3].…”

“…persistently throughout both workup and treatment. It has been reported that nearly normal hematologic values are associated with certain cases of ALL involving bone pain [2,7,8]. One retrospective review of 296 patients [8] found that those presenting with the primary complaint of bone pain, compared with those with predominant symptoms of another type, tended towards nearly normal hemoglobin concentration, leukocyte, absolute neutrophil, and platelet counts.…”