Assessment of Corticosteroid-induced Osteonecrosis in Children Undergoing Chemotherapy for Acute Lymphoblastic Leukemia

Hyakuna, Nobuyuki; Shimomura, Yasuto; Watanabe, Arata; Taga, Takashi; Kikuta, Atsushi; Matsushita, Takeji; Kogawa, Kazuhiro; Kawakami, Chihiro; Hirono, Yasuo; Iwai, Tsuyako; Okamoto, Yasuhiro; Tsurusawa, Masahito; Asami, Keiko

doi:10.1097/mph.0000000000000039

Cited by 37 publications

(30 citation statements)

References 17 publications

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“…The findings of our study indicate that the frequency of ON correlates well with age 10 years or older and IR/HR protocol but not with sex. Our result is in accordance with that reported by Girard et al but diverges from that reported by Hyakuna et al and the Winkle et al, who noted that females aged 10 years and older are at a higher risk for ON and that the risk of ON should be considered when administering dexamethasone as part of the ALL treatment protocol for females aged 10 years and older . The pathogenesis and impact of sex on the development of ON remain unclear and require further investigation.…”

Section: Discussionsupporting

confidence: 90%

“…Lower frequencies have been reported by other studies, such as that by Hyakuna et al, who reported an overall ON incidence of 1.5% (16/1095). Studies in Europe and the United States have shown highly variable results (1% to 2% up to 9%), depending on patient characteristics and treatment intensity . Strauss and Burger reported an estimated cumulative incidence of symptomatic ON in newly diagnosed ALL patients of 3.4% at eight years, while in our study, the cumulative incidence at five years was 11.96 ± 0.13.…”

Section: Discussioncontrasting

confidence: 52%

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Osteonecrosis in children with acute lymphoblastic leukemia: A report from Children's Cancer Hospital Egypt (CCHE)

Ali

Gohar

Zaky

et al. 2018

Pediatric Blood & Cancer

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Background: As survival rates for children with acute lymphoblastic leukemia (ALL) improve, awareness of treatment complications becomes important. Osteonecrosis (ON) is a serious disabling complication in treated ALL patients. The aim of the study was to define the frequency of ON identified by magnetic resonance imaging (MRI) and to study the risk factors for ON. Patients and methods:The frequency of ON was evaluated retrospectively in 858 patients with ALL who were diagnosed at Children's Cancer Hospital of Egypt from January 2009 to December 2012. Patients were treated with St Jude Total Therapy Study XV.Results: Of 858 patients evaluated, 665 were eligible for the study and 65 (9.7%) developed ON.The cumulative 5-year incidence of ON was 11.96% (SE, 0.131%). Of 154 patients aged 10 years and older, 40 (26%) developed ON. The mean age of patients with ON was 10.7 years. The prognostic factors with a significant relationship with ON were age 10 years and older (P = 0.0001) and intermediate-/high-risk group (P = 0.0001). However, gender did not have a significant relationship. At the onset of ON, the mean cumulative dexamethasone dose was 796 mg/m 2 , and the mean total corticosteroid dose, calculated as prednisolone equivalence, was 6,431 mg/m 2 .Out of 43 patients who developed ON while on corticosteroid therapy, 36 (84%) required dexamethasone dose modification and/or discontinuation. Conclusion:The frequency of ON among the studied patients was 9.7%. Risk factors with a significant association with ON were older age and more intensive corticosteroid therapy.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 52%

Osteonecrosis in children with acute lymphoblastic leukemia: A report from Children's Cancer Hospital Egypt (CCHE)

Ali

Gohar

Zaky

et al. 2018

Pediatric Blood & Cancer

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“…BCP‐ALL was then diagnosed at the age of 15 years. She was treated using a modified high‐risk protocol of the Japanese Children's Cancer and Leukemia Study Group 2004 without excess toxicity . Although she requires estrogen replacement due to ovarian dysfunction, she has been in continuous remission for 12 years since the diagnosis of ALL.…”

Section: Resultsmentioning

confidence: 99%

Acute lymphoblastic leukemia in patients with Down syndrome with a previous history of acute myeloid leukemia

Tomizawa

Endo

Kajiwara

et al. 2016

Pediatric Blood & Cancer

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Patients with Down syndrome (DS) are predisposed to acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in early and later childhood, respectively, but rarely experience both. We herein discuss four patients with DS with ALL and a history of AML who were treated with various chemotherapies, one of whom later received a bone marrow transplantation. Three patients survived and remain in remission. One patient died of fulminant hepatitis during therapy. No common cytogenetic abnormalities in AML and ALL besides constitutional +21 were identified, indicating that the two leukemia types were independent events. However, the underlying pathomechanism of these conditions awaits clarification.

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“…Additional risk factors for ON include age >10 years, obesity, Caucasian race, treatment intensity and asparaginase use (Mattano et al 2000 ;Niinimaki et al 2007 ;Kawedia et al 2011 ). While many children treated for ALL have evidence of ON on magnetic resonance imaging (MRI), symptomatic ON incidence is <20 % (Mattano et al 2000 ;Kawedia et al 2011 ;Hyakuna et al 2014 ).…”

Section: Osteonecrosismentioning

confidence: 99%

Pain Management

Malhotra¹,

Maurer²

2014

Supportive Care in Pediatric Oncology

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Pain is a common and often underreported and undertreated symptom in children with cancer. Recognition of pain and prompt and vigilant treatment are essential facets of high quality patient care. This chapter serves to provide an overview of the assessment and management of pain in pediatric oncology patients. The ability to assess pain in children of all ages and developmental ability as well as identify and diagnose different pain types is an imperative skill, and various assessment tools are discussed. Management of pain in children is based on the World Health Organization's pain ladder, and a step-by-step approach to opioid management is provided along with case examples and common side

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Assessment of Corticosteroid-induced Osteonecrosis in Children Undergoing Chemotherapy for Acute Lymphoblastic Leukemia

Abstract: Supplemental Digital Content is available in the text.

Cited by 37 publications

References 17 publications

Osteonecrosis in children with acute lymphoblastic leukemia: A report from Children's Cancer Hospital Egypt (CCHE)

Osteonecrosis in children with acute lymphoblastic leukemia: A report from Children's Cancer Hospital Egypt (CCHE)

Acute lymphoblastic leukemia in patients with Down syndrome with a previous history of acute myeloid leukemia

Pain Management

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