Symptomatic osteonecrosis in childhood leukemia survivors: prevalence, risk factors and impact on quality of life in adulthood

Abstract

Articleshaematologica | 2013; 98 (7) 1089Corticosteroid can induce osteonecrosis in children with leukemia. Few studies have been designed to assess the influence of a wide range of cumulative steroid dose on this side effect. Prevalence, risk factors of symptomatic osteonecrosis and its impact on adults' Quality of Life were assessed in 943 patients enrolled in the French "Leucémies de l'Enfant et de l'Adolescent" (LEA) cohort of childhood leukemia survivors. During each medical visit, data on previous osteonecrosis diagnosis were retrospectively collected. Patients without a history but with suggestive symptoms were investigated with magnetic resonance imaging. The total steroid dose in equivalent of prednisone was calculated for each patient and its effect on osteonecrosis occurrence was studied in multivariate models. Cumulative incidence was 1.4% after chemotherapy alone versus 6.8% after transplantation (P<0.001). A higher cumulative steroid dose, age over ten years at diagnosis, and treatment with transplantation significantly increased the risk of osteonecrosis. A higher post-transplant steroid dose and age over ten years at time of transplantation were significant factors in the transplanted group. With patients grouped according to steroid dose quartile, cumulative incidence of osteonecrosis reached 3.8% in the chemotherapy group for a dose beyond 5835 mg/m 2 and 23.8% after transplantation for a post-transplant dose higher than 2055 mg/m 2 . Mean physical composite score of Quality of Life was 44.3 in patients with osteonecrosis versus 54.8% in patients without (P<0.001). We conclude that total and post-transplant cumulative steroid dose may predict the risk of osteonecrosis, a rare late effect with a strong negative impact on physical domains of Quality of Life. Symptomatic osteonecrosis in childhood leukemia survivors: prevalence, risk factors and impact on quality of life in adulthood

Osteonecrosis in children with acute lymphoblastic leukemia

“…3,47 In study AALL02 32,38 of dexamethasone and compared cumulative prednisoneequivalent doses of GCs, showing no significant correlation with the occurrence of osteonecrosis. 10,33,46 However, as dexamethasone is known to be more toxic to the skeletal system than prednisone, and low dexamethasone clearance was linked to severe osteonecrosis, 6 this approach might conceal differences.…”

“…3 Furthermore, total body irradiation (TBI) and chronic graft-versus-host disease correlate with the incidence of osteonecrosis. …”

“…Osteonecrosis is one of the most common and debilitating therapy-related side effects of anti-leukemic treatment and can adversely affect long-term quality of life. 3 Incidence (1.6-17.6%) and risk factors for the development of osteonecrosis have been investigated in many studies, but results vary substantially between study groups and therapeutic regimens. [4][5][6][7][8][9] Adolescence is the most consistently identified and most significant risk factor, with patients >10 years old at the highest risk.…”

Health status of childhood leukemia survivors who received hematopoietic cell transplantation after BU or TBI: an LEA study

“…9 Assessment of health status and long-term late effects Late effects were detected by physicians through regular visits to reference centers, comprising medical examination and adequate laboratory tests.…”

Avascular necrosis of bone in childhood cancer patients: a possible role of genetic susceptibility

“…Some of them, such as osteonecrosis of bone, can sometimes be devastating (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Osteonecrosis (ON) is also referred to as avascular necrosis (AVN), "aseptic necrosis," and "ischemic bone necrosis".…”