AVASCULAR NECROSIS—AN ANTINEPOLASTIC TREATMENT RELATED TOXICITY: The Experiences of Two Institutions

Harila‐Saari

Pediatric Blood & Cancer

2014

Osteonecrosis is a well-recognized complication in patients with childhood leukemia. Its clinical relevance is highly dependent on the size and location of the lesion. Therefore, the diagnosis, description of the affected site and the classification of the disease, must be precise. We conducted an extensive literature review to assess the quality of studies reporting the incidence of osteonecrosis in patients with childhood leukemia. Of the 31 included studies, one-third (32% [n = 10]) did not describe the diagnostic method that was used to assess osteonecrosis. In almost two-third (61% [n = 19]) of the studies, the osteonecrosis classification system was not used. We conclude that the quality of most published studies on the incidence of osteonecrosis in patients with childhood leukemia is relatively poor because many studies did not describe the radiological method used to diagnose osteonecrosis and/or did not use a validated osteonecrosis classification system. To compare the incidence of osteonecrosis, and to assess the severity and clinical consequences of osteonecrosis in patients with childhood leukemia, there is a need for a robust and widely recognized classification system to grade all cases of osteonecrosis despite the site of lesion. Pediatr Blood Cancer 2015;62:198-203. © 2014 Wiley Periodicals, Inc.

Section: Resultsmentioning

confidence: 99%

The diagnosis and classification of osteonecrosis in patients with childhood leukemia

Harila‐Saari

Pediatric Blood & Cancer

2014

International Journal of Surgery Case Reports

“…Several other studies cite a combination of chemoradiotherapy as a causal factor for ON regardless of the type of cancer or the age of the patient. [10][11][12] Ojala et al report a 32% incidence (9/28) of osteonecrosis (ON) in a paediatric population undergoing treatment for ALL of which 14.3% were symptomatic. 13 All patients that developed ON in their cohort were in the intermediate to high risk category and received a combination of chemotherapy (vincristine, doxorubicin, cyclophosphamide, mercaptopurine, cytosine, teniposide and methotrexate), steroidal treatment and cranial irradiation.…”

Section: Discussionmentioning

confidence: 99%

Multimodality treatment of a complex series of parallel pathologies in a 16-year-old male that ultimately leads to bilateral hip arthroplasty surgery: A case report

Cullen

Quinlan

Fogarty

et al. 2012

“…The distal femur and proximal tibia, humeral head, talus and capitellum may also be involved (8). Concurrent hip and knee involvement in steroid-induced AVN was described only in 13 patients with severe acute respiratory syndrome, non-Hodgkin lymphoma, acute lymphoblastic leukemia, and ulcerative colitis (6)(7)(8)(9).…”

Section: F I G U R E 3 S a G I T T A L T 1 -We I G H T E D ( A-b ) mentioning

confidence: 99%

“…Havel et al determined AVN of bilateral lateral femoral condyles due to high dose steroid use in a patient with mixed connective-tissue disease and thrombocytopenic purpura (4). Though it is frequent in different diseases due to steroid use, hip-and-knee concomitant and very early diagnosed AVN in these groups are rare (3)(4)(5)(6)(7)(8)(9). The present case report is the first to define concurrent hip and knee AVN at a very early stage due to steroid use in a patient with ITP.…”

Section: Introductionmentioning

confidence: 99%

Very Early Onset Steroid-Induced Avascular Necrosis of the Hip and Knee in a Patient with Idiopathic Thrombocytopenic Purpura

2008

Avascular necrosis (AVN) is a devastating adverse effect of steroid therapy rarely reported in idiopathic thrombocytopenic purpura (ITP). We describe a 64-year-old woman with progressive left knee and hip pain for 30 days resulting with the inability to ambulate. After she had been diagnosed ITP pulse steroid treatment was started in the department of Hematology. Two weeks later she described left knee and left hip pain. On physical examination, motion in her left knee and hip was severely painful without inflammation but range of motion was not limited. Magnetic resonance imaging showed multiple bony infarcts in the proximal femur, distal femur and proximal tibia, consistent with AVN. This case report is the first to define concurrent hip and knee AVN at a very early stage due to steroid use in a patient with ITP.