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

Abstract

Background: As survival rates for children with acute lymphoblastic leukemia (ALL) improve, awareness of treatment complications becomes important. Osteonecrosis (ON) is a serious disabling complication in treated ALL patients. The aim of the study was to define the frequency of ON identified by magnetic resonance imaging (MRI) and to study the risk factors for ON. Patients and methods:The frequency of ON was evaluated retrospectively in 858 patients with ALL who were diagnosed at Children's Cancer Hospital of Egypt from January 2009 to December 2012. Patients were treated with St Jude Total Therapy Study XV.Results: Of 858 patients evaluated, 665 were eligible for the study and 65 (9.7%) developed ON.The cumulative 5-year incidence of ON was 11.96% (SE, 0.131%). Of 154 patients aged 10 years and older, 40 (26%) developed ON. The mean age of patients with ON was 10.7 years. The prognostic factors with a significant relationship with ON were age 10 years and older (P = 0.0001) and intermediate-/high-risk group (P = 0.0001). However, gender did not have a significant relationship. At the onset of ON, the mean cumulative dexamethasone dose was 796 mg/m 2 , and the mean total corticosteroid dose, calculated as prednisolone equivalence, was 6,431 mg/m 2 .Out of 43 patients who developed ON while on corticosteroid therapy, 36 (84%) required dexamethasone dose modification and/or discontinuation. Conclusion:The frequency of ON among the studied patients was 9.7%. Risk factors with a significant association with ON were older age and more intensive corticosteroid therapy.

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

“…Cumulative dose and schedule of administration of corticosteroids are associated with development of AVN 6,7,13,20 . Association with other factors including sex, body mass index, and use of high dose methotrexate and asparaginase were reported but the findings were not consistent across studies 6,8,14,21,22 …”

“…6 The reported incidence of AVN varied significantly among study groups and treatment protocols and ranged from 1.4% to 25% for symptomatic cases. 2,3,[6][7][8][9][10][11][12] The difference in incidence could be accountable by the difference in study population, treatment factors, timing of radiological investigation, and imaging modality used to diagnose AVN. 11 It was reported that the risk of AVN differed between ethnic groups, and was more common in White than in Blacks.…”

“…6,7,13,20 Association with other factors including sex, body mass index, and use of high dose methotrexate and asparaginase were reported but the findings were not consistent across studies. 6,8,14,21,22 Magnetic resonance imaging (MRI) is now regarded as the standard method for diagnosing AVN. 6,7,14,22,23 In patients with imaging features of AVN, it is recognized that some changes may remain stable over time, while some will progress.…”

“… 6 , 7 , 13 , 20 Association with other factors including sex, body mass index, and use of high dose methotrexate and asparaginase were reported but the findings were not consistent across studies. 6 , 8 , 14 , 21 , 22 …”

Osteonecrosis in Korean Paediatric and Young Adults with Acute Lymphoblastic Leukaemia or Lymphoblastic Lymphoma: A Nationwide Epidemiological Study

“…ON incidence varies widely (1.6-17.6%) depending on the study cohort and treatment protocol [5][6][7][8][9][10][11][12][13][14][15]. ON aetiology is multifactorial, with risk factors such as steroid use, sex, body mass index (BMI) [16], genetics [2,7,10,17,18], haematopoietic stem cell transplantation (HSCT) [19] and antileukaemic agents [1,3,11,[19][20][21][22][23][24][25][26]. Despite many studies, the results remain debatable [1,21,27], although adolescents aged 10 years and older have the highest risk of developing ON [3,12,22,24,28].…”