Aseptic Osteonecrosis in Children and Adolescents Treated for Hemato-Oncologic Diseases

Lackner, Herwig; Benesch, Martin; Moser, Andrea; Smolle-Jüttner, Freya; Linhart, Wolfgang E.; Raith, J.; Urban, Christian

doi:10.1097/01.mph.0000163215.37147.13

Cited by 51 publications

(47 citation statements)

References 22 publications

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“…[7][8][9][10][11]43,62 In contrast, the incidence is lower in adults undergoing ALL therapy. 36 Thus, the pathogenesis of osteonecrosis is likely strongly associated with factors being most prominent in adolescent age, thereby causing the highest vulnerability for osteonecrosis in this age.…”

Section: Adolescencementioning

confidence: 99%

“…[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. [7][8][9][10][11] As this dominates all other therapy-related and patient-specific risk factors, it suggests that the underlying pathophysiology for the development of osteonecrosis likely has to be attributed to agespecific factors ultimately affecting bone morphology, metabolism, and/or nourishment. This may be due, at least in part, to increased end-organ susceptibility caused by a markedly increased growth rate and specific hormonal changes in this period of life.…”

Section: Introductionmentioning

confidence: 99%

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Osteonecrosis in children with acute lymphoblastic leukemia

et al. 2016

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Section: Adolescencementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Osteonecrosis in children with acute lymphoblastic leukemia

et al. 2016

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“…In clinical practice, a dexamethasone dose ranging from 10 to 14 mg/m 2 is usually used [2,15,28]. In regard to the safety of corticosteroids, it has to be considered that corticosteroid treatment, especially in children older than 10 years, increases the risk of aseptic osteonecrosis [6,20,28]. Furthermore, laboratory studies suggest steroids may interfere with response to chemotherapy in osterosarcoma cell lines, but this has not been shown in vivo [9].…”

Section: Corticosteroidsmentioning

confidence: 99%

Antiemetics in children receiving chemotherapy. MASCC/ESMO guideline update 2009

Jordan¹,

Roila

Molassiotis

et al. 2010

Support Care Cancer

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Only a few studies have been carried out in children on the prevention of chemotherapy-induced nausea and vomiting (CINV). 5-HT 3 receptor antagonists have been shown to be more efficacious and less toxic than metoclopramide, phenothiazines and cannabinoids. Most dose studies are available for the 5-HT 3 receptor antagonists ondansetron and granisetron. The new 5-HT 3 receptor antagonist palonosetron was evaluated in one comparative study so far showing promising activity. Combinations of a 5-HT 3 receptor antagonist and dexamethasone showed increased efficacy with respect to a 5-HT 3 receptor antagonist alone. All paediatric patients receiving chemotherapy of high or moderate emetogenic potential should receive a combination of a 5-HT 3 receptor antagonist and dexamethasone to prevent acute emesis. No studies have specifically evaluated antiemetic drugs in the prevention of chemotherapy-induced delayed and anticipatory emesis in children. The role of the NK1 receptor antagonists in children has to be further investigated, although one small study is published so far, showing promising activity in the prevention of CINV with aprepitant. The new proposed guideline from the Multinational Association of Supportive Care in Cancer and the European Society of Clinical Oncology summarises the updated data from the literature and takes into consideration the existing guidelines.

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“…Although several factors are associated with the etiology of ON, exposure to glucocorticoids (especially prolonged treatment with dexamethasone [6][7][8] ) and diagnosis between 10 and 20 years of age 9,10 have been consistently associated with higher risk of ON. There are only a few studies of patients older than 20 years of age, one of which found that individuals younger than 20 years of age are at higher risk of ON than patients older than 20.…”

mentioning

confidence: 99%

“…6,7 However, patients with hematological malignancies seem to have a remarkably higher incidence of ON. In patients with pediatric or adolescent acute lymphoblastic leukemia (ALL), the incidence of symptomatic ON has been reported to vary from 1.1% to 9.3%, 7,9,10,15 but magnetic resonance imaging (MRI) screening has revealed that the incidence may actually range from 15.5% to 38%. [16][17][18] MRI has been established as the most sensitive method for the early diagnosis of ON.…”

mentioning

confidence: 99%

Incidence of Severe Osteonecrosis Requiring Total Joint Arthroplasty in Children and Young Adults Treated for Leukemia or Lymphoma: A Nationwide, Register-Based Study in Finland and Denmark

Niinimäki

Hansen

Niinimäki

et al. 2013

Journal of Adolescent and Young Adult Oncology

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Purpose: The population-based incidence of severe osteonecrosis (ON) necessitating total joint arthroplasty (TJA) in patients with hematological cancer is unknown. This study assessed the incidence of ON requiring primary TJA in children and young adults treated for leukemia or lymphoma. Methods: Patients diagnosed with leukemia or lymphoma before 31 years of age were identified from the Finnish and Danish Cancer Registries. These data were combined with those from the National Hospital Discharge and the Finnish Arthroplasty Registers. Data on the orthopedic procedures performed and the appropriate diagnosis codes given before the age of 40 were also retrieved. Results: The estimated cumulative incidence of TJA was 4.5% at 20 years for patients treated for chronic myeloid leukemia, followed by 2.1% for patients treated for acute myeloid leukemia. It was considerably lower in patients with acute lymphoblastic leukemia (ALL; 0.4%). Multivariate analysis revealed that allogeneic stem cell transplantation (allo-SCT) increased the risk of TJA (hazard ratio [HR] = 9.4; 95% CI: 5.3-16.9). The risk of TJA was higher in patients diagnosed with cancer at 10-19 and 20-30 years of age than in those diagnosed before the age of 10 (HR = 24; 95% CI: 3.1-176 and HR = 26; 95% CI: 3.6-192 respectively). Conclusion: The incidence of ON requiring TJA was highest among patients with myeloid leukemias and lowest in patients treated for ALL. Allo-SCT and age q10 years at diagnosis were the most important risk factors for ON requiring TJA in hematological malignancies.

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Aseptic Osteonecrosis in Children and Adolescents Treated for Hemato-Oncologic Diseases

Cited by 51 publications

References 22 publications

Osteonecrosis in children with acute lymphoblastic leukemia

Osteonecrosis in children with acute lymphoblastic leukemia

Antiemetics in children receiving chemotherapy. MASCC/ESMO guideline update 2009

Incidence of Severe Osteonecrosis Requiring Total Joint Arthroplasty in Children and Young Adults Treated for Leukemia or Lymphoma: A Nationwide, Register-Based Study in Finland and Denmark

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