Osteonecrosis in pediatric cancer survivors: Epidemiology, risk factors, and treatment

Rao, Sandesh S.; Abiad, Jad M. El; Puvanesarajah, Varun; Levin, Adam S.; Jones, Lynne C.; Morris, Carol D.

doi:10.1016/j.suronc.2019.02.001

Cited by 11 publications

(9 citation statements)

References 104 publications

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“…There is substantial interest in identifying alternative treatments for osteonecrosis in this young patient population. Proposed interventions encompass both pharmacologic and nonpharmacologic approaches 44 . Pharmacologic approaches include treatment with prostacyclin analogs, low‐molecular‐weight heparin, statins, and bisphosphonates.…”

Section: Team Approachmentioning

confidence: 99%

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Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia

Jones

Kaste

Karol

et al. 2020

Pediatric Blood & Cancer

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With current treatments for acute lymphoblastic leukemia (ALL), the overall prognosis for survival is favorable. Increasing emphasis is placed on recognizing and managing the long-term consequences of ALL and its treatment, particularly involving osteonecrosis. Early osteonecrosis diagnosis and management may improve outcomes and is best accomplished through coordinated teams that may include hematologic oncologists, radiologists, orthopedic surgeons, physical therapists, and the patient and their family. Magnetic resonance imaging is the "gold standard" for diagnosis of early-stage and/or multifocal osteonecrosis. Treatments for osteonecrosis in ALL patients are risk stratified and may include observation, corticosteroid or chemotherapy adjustment, and pharmaceutical or surgical approaches.

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Section: Team Approachmentioning

confidence: 99%

“…Studies have reported variable results for pamidonate, 45,46 alendronate, 47,48 zoledronic acid, 49 and combination therapy (alendronate and zoledronic acid) 50,51 . The reader is referred to several detailed reviews of these treatment strategies 32,41,44 …”

Section: Team Approachmentioning

confidence: 99%

Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia

Jones

Kaste

Karol

et al. 2020

Pediatric Blood & Cancer

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“…There is no single agreed-upon surgical approach in pediatric ON, in part due to the young age and skeletal immaturity of pediatric patients. In general, total joint replacement is delayed as long as possible as children are expected to significantly outlive their prostheses [63,65]. Promising new approaches include core decompression with implantation of autologous mesenchymal stem cell therapy [66] and the use of hyperbaric oxygen therapy (HBOT) [67,68].…”

Section: Osteonecrosis In Childhood Leukemia: Treatment Strategies Anmentioning

confidence: 99%

“…Promising new approaches include core decompression with implantation of autologous mesenchymal stem cell therapy [66] and the use of hyperbaric oxygen therapy (HBOT) [67,68]. Controversial is the use of medical therapies targeting pathophysiologic mechanisms such as bone metabolism, lipid metabolism or microvascular health, and including calcium channel blockers, prostaglandins (iloprost), low molecular weight heparin, statins, and bisphosphonates [63,65]. Similarly, there have been no large studies of bisphosphonates for ON in childhood leukemia survivors and for this reason, indication and expected outcomes for treatment remain unclear [69][70][71][72][73].…”

Section: Osteonecrosis In Childhood Leukemia: Treatment Strategies Anmentioning

confidence: 99%

Pain Management in Childhood Leukemia: Diagnosis and Available Analgesic Treatments

Coluzzi

Rocco

Gladden

et al. 2020

Cancers

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Pain is one of the most common symptoms in children suffering from leukemia, who are often misdiagnosed with other childhood painful diseases such as juvenile idiopathic arthritis. Corticosteroid-induced osteonecrosis (ON) and vincristine-induced peripheral neuropathy (VIPN) are the most common painful manifestations. Additionally, ongoing pain may continue to impact quality of life in survivorship. This narrative review focuses on the pathophysiological mechanisms of pain in childhood leukemia and current available indications for analgesic treatments. Pain management in children is often inadequate because of difficulties in pain assessment, different indications across countries, and the lack of specific pediatric trials. Analgesic drugs are often prescribed off-label to children by extrapolating information from adult guidelines, with possible increased risk of adverse events. Optimal pain management should involve a multidisciplinary team to ensure assessment and interventions tailored to the individual patient.

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“…The pathogenesis of ONFH remains unclear, however, several reports have suggested possible pathogenesis, such as abnormality of lipid metabolism, thrombosis, and oxidative stress [ 5 – 7 ]. Several cancer treatment regimens also have been reported to be associated with the development of osteonecrosis, including radiation therapy; corticosteroid medications; immunotherapy, including anti-angiogenic agents; and several chemotherapeutic agents [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for osteonecrosis of the femoral head in brain tumor patients receiving corticosteroid after surgery

et al. 2020

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Non-traumatic osteonecrosis of the femoral head (ONFH) is a plausible complication in brain tumor patients. Frequent use of corticosteroid therapy, chemotherapy, and oxidative stress for managing brain tumors may be associated with the development of ONFH. However, there is little knowledge on the prevalence and risk factors of ONFH from brain tumor. This study aimed to investigate the prevalence and risk factors of ONFH in patients with primary brain tumors. Methods This retrospective cohort study included data from consecutive patients between December 2005 and August 2016 from a tertiary university hospital in South Korea. A total of 73 cases of ONFH were identified among 10,674 primary brain tumor patients. After excluding subjects (25 out of 73) with missing data, history of alcohol consumption or smoking, history of femoral bone trauma or surgery, comorbidities such as systemic lupus erythematosus (SLE), sickle cell disease, cancer patients other than brain tumor, and previous diagnosis of contralateral ONFH, we performed a 1:2 propensity score-matched, case-control study (ONFH group, 48; control group, 96). Risk factors of ONFH in primary brain tumor were evaluated by univariate and multivariate logistic regression analyses. Results The prevalence of ONFH in patients with surgical resection of primary brain tumor was 683.9 per 100,000 persons (73 of 10,674). In this cohort, 55 of 74 patients (74.3%) underwent THA for ONFH treatment. We found that diabetes was an independent factor associated with an increased risk of ONFH in primary brain tumor patients (OR = 7.201, 95% CI, 1.349-38.453, p = 0.021). There was a significant difference in univariate analysis, including

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Osteonecrosis in pediatric cancer survivors: Epidemiology, risk factors, and treatment

Cited by 11 publications

References 104 publications

Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia

Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia

Pain Management in Childhood Leukemia: Diagnosis and Available Analgesic Treatments

Risk factors for osteonecrosis of the femoral head in brain tumor patients receiving corticosteroid after surgery

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