Incidence, risk factors, and treatment outcome of symptomatic osteonecrosis in Taiwanese children with acute lymphoblastic leukemia: a retrospective cohort study of 245 patients in a single institution

Abstract

Osteonecrosis (ON) is a potentially disabling complication encountered in children who receive chemotherapy for acute lymphoblastic leukemia (ALL). Considering the possible effect of ethnic difference on the clinical features of symptomatic ON in pediatric ALL, we retrospectively evaluated 245 children with ALL who were treated at Chang Gung Memorial Hospital, Linkou, between 2002 and 2011. Six (2.4 %) patients developed symptomatic ON in a total of 17 sites during the follow-up period. Diagnosis of ON was confirmed by X-ray in seven, magnetic resonance imaging in two, and bone scan in three patients. The estimated cumulative incidence of symptomatic ON in newly diagnosed ALL was 3.4 % at 8 years. Four patients received ON-directed surgical interventions, including total hip replacement in three and arthroplasty in one. The incidence of ON was significantly higher among girls (P = 0.03), patients >10 years old (P = 2.2 × 10(-4)), and patients who had received more intensive chemotherapy regimen (P = 0.02). These results indicate that the incidence and risk factors in our institute were similar to those observed in Western countries. Future studies surveying the impact on the quality of life of childhood ALL survivors in Taiwan are warranted.

Osteonecrosis in children with acute lymphoblastic leukemia: A report from Children's Cancer Hospital Egypt (CCHE)

“…In this study, the IR/HR treatment protocol was a significant risk factor for the development of ON ( P < 0.0001). This result was in agreement with that of Shih‐Hsiang Chen and Kawedia et al, who reported a higher risk of ON in HR cohorts confounded by age and steroid intensity . The dexamethasone dose received by patients in this study was higher with the IR/HR protocol than with the LR protocol.…”

“…Recent advances in chemotherapy, risk‐adapted treatment, and adequate supportive care have significantly improved the outcome of pediatric patients with acute lymphoblastic leukemia (ALL); the cure rate is approximately 80%–90%, but significant toxicity remains a major challenge that significantly impacts the long‐term quality of life . Osteonecrosis (ON) is defined as the aseptic or avascular necrosis of bone and is characterized by the death of one or more bone segments .…”

The incidence, risk factors, and outcomes of symptomatic avascular necrosis of bone among Chinese pediatric patients with acute lymphoblastic leukemia

“…In this retrospective cohort study on AVN among Chinese children with ALL, the incidence of symptomatic AVN for patients ≥10 years old was 18.2%, which was comparable to Western studies and was higher than that reported in the CCCG‐ALL‐2015 study 2,5,6,9,12,13,20,27,28 . Multiple joints involvement were common with hips and knees being the most commonly affected joints 9,22 .…”

The incidence of symptomatic osteonecrosis is similar between Japanese children and children in Western countries with acute lymphoblastic leukaemia treated with a Berlin‐Frankfurt‐Münster (BFM)95‐based protocol

“…2 Previous reports revealed an incidence ranging from 0Á67% to 15% of children treated for ALL. [3][4][5][6] Previously, we reported a low frequency of symptomatic ON in the Japan Association of Childhood Leukemia Study Group (JACLS) ALL-97 and ALL-02 studies of Japanese cohorts. 7 We postulated that the low incidence of symptomatic ON may be due to the lower cumulative dose of combination dexamethasone (DEX) and L-asparaginase (L-asp) than that used in Western countries.…”

“…However, one of the most common therapy‐related toxicities in children with ALL is glucocorticoid‐induced osteonecrosis (ON) 2 . Previous reports revealed an incidence ranging from 0·67% to 15% of children treated for ALL 3–6 …”