Osteonecrosis of the femoral head in patients with lymphoma treated with intermittent combination chemotherapy (including corticosteroids)

Abstract

Four adult patients with malignant lymphoma were treated with combination chemotherapy including an alkylating agent, vincristine, procarbazine (in all but one case), and intermittent high-dose prednisone. Twenty to 42 months after initiation of therapy, osteonecrosis of the femoral head developed. This was bilateral in two patients and unilateral in two, and presumably represented a complication of steroid administration, even though three of the patients received only 4 to 6 weeks of therapy. Necrosis of bone may be a low-frequency long-term complication of combination chemotherapy in lymphoma.

Osteonecrosis in Children Treated for Lymphoma or Solid Tumors

“…17 The prevalence of ON in adults has varied within 0.12% to 14% in patients with NHL and within 1.6% to 15% in patients with HD. [18][19][20] There are 2 retrospective studies of patients with symptomatic ON including children treated for various malignancies.…”

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

“…[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.…”

Tongue Infarction Following Combination Chemotherapy For Advanced Hodgkin’s Disease A Case Report

“…Prolonged steroid administration is an attributed cause of avascular necrosis of bone but not tongue infarction. 6 We are not aware of any report of venous or arterial thrombophlebitis and tongue necrosis secondary to the administration of vincristine alone, or in sequence with that of nitrogen mustard or cyclophosphamide. The patient's tongue lesion continued to heal despite the uninterrupted administration of procarbazine.…”