Avascular Necrosis of Bone: A Complication of Aggressive Therapy for Acute Lymphoblastic Leukemia

Vaidya, Sucheta; Saika, Shizuya; Sirohi, Bhawna; Pai, Sheila R; Advani, Suresh H.

doi:10.1080/028418698429739

Cited by 22 publications

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Osteonecrosis (ON) was diagnosed in nearly one‐third of patients who received intensification. This rate is higher than reported in retrospective paediatric ALL series (Vaidya et al , 1998; Patel et al , 2008), and is probably related to the high doses of corticosteroids used in this protocol, possibly exacerbated by the high doses of asparaginase. However, the cumulative incidence may actually be higher, as magnetic resonance imaging scans were mainly performed in symptomatic patients and not routinely; ON is frequently asymptomatic in the early stages (Ojala et al , 1997).…”

Section: Discussioncontrasting

confidence: 64%

Treatment of adults with BCR‐ABL negative acute lymphoblastic leukaemia with a modified paediatric regimen

et al. 2009

View full text Add to dashboard Cite

Summary Between 2000 and 2006, 85 adult BCR‐ABL negative acute lymphoblastic leukaemia (ALL) patients between 18 and 60 years of age were treated using a modified paediatric regimen, which included high doses of asparaginase delivered weekly for 30 weeks during intensification. The complete response rate with induction therapy was 89%, and decreased with increasing age, mainly due to higher induction mortality. All post‐induction treatments were delivered on an outpatient basis. The most common complications during intensification were infections (47%), osteonecrosis (32%), venous thromboembolism (23%) and neuropathy (22%). At a median follow‐up of 4 years, the 5‐year overall survival (OS) and relapse‐free survival (RFS) were 63% and 71%, respectively. Significant adverse predictors for OS were age >35 years, high white blood cell count, MLL rearrangement, allogeneic stem cell transplantation in first complete remission and <80% of the planned asparaginase dose delivered during intensification. Patients aged ≤35 years had a 3 year OS of 83%, as compared to 52% for patients aged >35 years. We conclude that the administration of this paediatric regimen is feasible and has considerable activity in adult ALL, particularly in younger patients. Effective delivery of asparaginase dosing appears to be important in achieving an optimal antileukaemic effect.

show abstract

Section: Discussioncontrasting

confidence: 64%

Treatment of adults with BCR‐ABL negative acute lymphoblastic leukaemia with a modified paediatric regimen

et al. 2009

View full text Add to dashboard Cite

show abstract

“…However, the results did not reach statistical significance. Vaidya et al [67], also agreed that the high cumulative doses of steroid were noted to have an increased risk of osteonecrosis in acute lymphocytic leukemia patients. In a small cohort of acute lymphocytic leukemia patients, Chan-Lam et al [72] reported 5/9 patients with osteonecrosis, which he proposes may be explained by their protocol of higher dose steroids (1.5-1.75× greater than in convention chemotherapy).…”

Section: Daily and Cumulative Dose In Malignancy (Bmt All MM Nhl mentioning

confidence: 91%

“…The overall incidence of 0 to 0.6% extracted from the scattered case reports and small studies is considerably lower than the other underlying diseases discussed thus far [58,59]. With regard to underlying malignancy and steroid induced osteonecrosis, the incidence varies widely between 0.6 and 3.4% [60][61][62][63][64][65][66][67][68][69][70][71][72][73]. It is difficult to make generalized statements regarding steroid dosing with these varied underlying disorders, but patterns are evident.…”

Section: Risk Of Osteonecrosis In Other Conditionsmentioning

confidence: 99%

Steroid induced osteonecrosis: An analysis of steroid dosing risk

Powell

Chang²,

Naguwa

et al. 2010

Autoimmunity Reviews

148

149

View full text Add to dashboard Cite

Osteonecrosis is a serious condition involving bone destruction that frequently requires surgical treatment to rebuild the joint. While there is an abundance of literature documenting corticosteroid related osteonecrosis, there is no consensus as to the relative risk of osteonecrosis after administration of steroids via parenteral, oral, topical, inhaled and other routes. This risk is an important prognostic indicator because identification and conservative intervention can potentially reduce morbidity associated with aggressive surgical treatment of osteonecrosis. This paper provides insight into establishing guidelines related to the risk of developing osteonecrosis as a result of corticosteroid use. Case studies, retrospective studies and prospective studies in humans on different corticosteroids and varied dosages were assessed. Most cases of osteonecrosis are secondary to systemically administered corticosteroids and/or high dose daily therapy, particularly in patients with underlying comorbidities including connective tissue diseases, hyperlipidemia, or previous trauma. Previous case reports of osteonecrosis related to inhaled or topical use of steroids are complicated by the fact that in the great majority of cases, the patients are also treated with systemic steroids prior to the development of osteonecrosis. Based on the literature, a set of recommendations regarding the risk of osteonecrosis in patients on steroids was formulated.

show abstract

“…Osteonecrosis, especially of the femoral head, can also occur in pregnancy [1,7]. An increase in the pressure within the bone marrow cavity, as a result of haemorrhage or cellular hyperproliferation (Gaucher's disease or in hypertrophy of adipocytes), can also lead to compression of blood vessels and dysfunction in local blood flow [8,9].…”

Section: Introductionmentioning

confidence: 99%

Avascular osteonecrosis of the hip in patient after adjuvant radiotherapy for rectal cancer

Michalecki¹,

Gabryś²,

Głowacki³

et al. 2014

View full text Add to dashboard Cite

Avascular Necrosis of Bone: A Complication of Aggressive Therapy for Acute Lymphoblastic Leukemia

Cited by 22 publications

References 14 publications

Treatment of adults with BCR‐ABL negative acute lymphoblastic leukaemia with a modified paediatric regimen

Treatment of adults with BCR‐ABL negative acute lymphoblastic leukaemia with a modified paediatric regimen

Steroid induced osteonecrosis: An analysis of steroid dosing risk

Avascular osteonecrosis of the hip in patient after adjuvant radiotherapy for rectal cancer

Contact Info

Product

Resources

About