Aseptic osteonecroses in the treatment of childhood acute leukaemias

Abstract

The incidence of aseptic osteonecroses in the therapy of acute leukaemias in children has been studied. Out of 551 children treated at the Children's Hospital in Münster from 1971 to 1985, 6 developed osteonecrosis, an incidence of 1.09%. Of these children, 5 showed unilateral or bilateral necrosis of the femoral head. The osteonecroses occurred 8-109 months after initiation of the primary therapy or of the relapse treatment. The corticoid doses did not differ from those administered to other leukaemia patients without necrosis. Only 1 patient had received prednisone continuously for 1 year, at a total dose of 20.5 g/m2 of body surface area. Of these 6 children, 4 had been immobilized for several weeks before or during therapy. Two children had presented with pain-related relieving posture of the joints in which subsequently the osteonecrosis developed. Inactivity associated with the cortisone therapy seems to be an important factor in the development of aseptic osteonecroses.

Osteonecrosis during the treatment of childhood acute lymphoblastic leukemia: A prospective MRI study

“…It has been generally believed that spontaneous regression or healing of osteonecrosis is extremely rare [31]. We have found few sporadic reports concerning children with steroid-related osteonecrosis with spontaneous resolution [14,32,33]. There are a few follow-up MRI studies among adult patients receiving corticosteroids and at risk for osteonecrosis, which suggests that in some patients osteonecrosis may have a benign course and even spontaneous improvement [34][35][36][37][38].…”

High incidence of avascular necrosis in adolescents with acute lymphoblastic leukaemia: a UKALL XII analysis

“…[1][2][3][4][5] Its development, in many cases, results in significant pain and loss of function sometimes necessitating joint replacement. 1 The majority of reported cases of AVN following therapy for ALL are in children.…”

MRI Evaluation of Aseptic Osteonecrosis in Children over the Course of Hyperbaric Oxygen Therapy

“…Among these organ damages, we encounter the development of aseptic osteonecrosis (AON) during or after chemotherapy. Although the incidence of AON in children with ALL and bone pain was initially found to be 1.13 % in a retrospective study of conventional radiographs [2], a prospective MRI study of ALL children shows frequencies significantly higher with up to 38 % [3].…”