Avascular necrosis of bone following an intensified chemotherapy regimen including high dose steroids

Thornton, Mark; O′Sullivan, G.; Williams, M.; Hughes, P. M.

doi:10.1016/s0009-9260(97)80253-x

Cited by 37 publications

(25 citation statements)

References 13 publications

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“…This finding is consistent with other reports that the frequency of AVNB is directly related to age in patients being treated for leukemia. 5 Body mass index, white blood cell count, sex, and cumulative dose of methotrexate were not found to be significantly associated with AVNB.…”

Section: Discussionmentioning

confidence: 83%

“…This observation is corroborated by several reports showing no significant correlation between the occurrence of AVNB and the cumulative prednisone-equivalent dose of corticosteroids. 5,19,30 It is possible that the cumulative dose of corticosteroids is related to the incidence of AVNB in a subset of patients, such as those above the age of 10 years.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Its reported frequency varies from 0% to 40%, depending on the type of therapy administered and the imaging methods employed to detect AVNB. 4,[6][7][8][9] Although the etiology of AVNB is not well understood, there is some evidence suggesting that AVNB results from ischemic insult to the bone and bone marrow.…”

Section: Introductionmentioning

confidence: 99%

“…After the addition of prednisone to the continuation chemotherapy regimen, AVNB was detected in 1.4% of patients. 6 The frequency of AVNB appears to be greater when dexamethasone is administered, 4,5,14,15 although this finding may reflect the greater dose intensity with which dexamethasone is usually given for acute lymphoblastic leukemia (ALL). The dose intensity of methotrexate or l-asparaginase given with glucocorticoids may also be factors in the development of AVNB.…”

Section: Introductionmentioning

confidence: 99%

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Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

Kennedy

et al. 2001

Leukemia

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The purpose of this study was to determine the frequency with which magnetic resonance (MR) imaging detects avascular necrosis of the bone (AVNB) in children with acute lymphoblastic leukemia (ALL) or advanced-stage non-Hodgkin lymphoma (NHL) who receive prednisone during remission induction, reinduction, and maintenance chemotherapy; to assess the clinical significance of these findings; and to identify factors predictive of AVNB. We prospectively obtained MR imaging of the hips and knees of 116 children who had completed at least 1 year of treatment for ALL or advanced-stage NHL on identical prednisone-containing regimens between December 1991 and October 1994. MR imaging findings of AVNB were compared with clinical outcomes, and the effect of therapeutic and patient factors on the frequency of AVNB was analyzed. The MR imaging findings of 17 of the 116 participating patients were consistent with AVNB. The most common clinical manifestation was joint pain (11 patients). Only one patient had progressive joint deterioration that necessitated surgical replacement. Only age 10 years or more at the time of the primary diagnosis was significantly associated with the development of AVNB (P = 0.004). MR imaging showed changes consistent with AVNB in approximately 15% of this patient population. However, most patients in this study who had MR imaging signs of AVNB did not experience progressive joint destruction, even with continued prednisone therapy. Therefore, the clinical usefulness of MR imaging as a screening tool for AVNB in this set of patients remains uncertain. Leukemia (2001) 15, 891-897.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

Kennedy

et al. 2001

Leukemia

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“…Chemotherapy associated bone pain in children leads to the differential diagnoses of therapy induced neuropathy, AON, osseous infection, and bone marrow infiltration by the underlying disease [11]. As a non-invasive diagnostic method with excellent soft-tissue contrast, MRI is the method of choice in evaluating bone marrow.…”

Section: Discussionmentioning

confidence: 99%

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

Scherer

Engelbrecht²,

Bernbeck³

et al. 2000

Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr

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RAPID COMMUNICATION nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nPurpose: The study aimed at MRI evaluation of aseptic osteonecrosis (AON) in children over the course of hyperbaric oxygen (HBO) therapy. Material and Methods: Retrospective analysis of 72 MRI studies in 20 children presenting with AON during chemotherapy. Two groups were differentiated: Gr. I (n = 8) was treated exclusively with relief of weightbearing structures, Gr. II (n = 12) was additionally treated with HBO therapy. The MRI examinations were evaluated by a point-score system (1 ± 6 points) by two radiologists. Results: Gr. II initially showed more severe findings (average score: 3.4) in comparison to Gr. I (average score: 2.65). During the follow-up time period the average scores rose to 3.2 score-points in Gr. I and 4.1 points in Gr. II. No statistically significant difference was evident between the two groups in the course of AON. Conclusion: The majority of chemotherapy associated AON which initially present with advanced findings show a progression in MRI over their further course. HBO therapy in addition to the relief of affected weightbearing structures statistically shows no significant improvement in MRI morphology during the course of the treatment.

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Decrease in motor performance in children with cancer is independent of the cumulative dose of vincristine

Hartman

Bos

Stijnen

et al. 2006

Cancer

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BACKGROUND.Impaired performance on motor tasks in children treated for acute lymphoblastic leukemia (ALL) after completion of treatment is often attributed to vincristine (VCR). Whether motor problems persist in other children who receive different cumulative doses of VCR is to the authors' knowledge not known. The objective of the current study was to determine the extent of motor problems in children with ALL, Wilms tumor (WT), B-cell non-Hodgkin lymphoma (B-NHL), and malignant mesenchymal tumors (MMT) and whether these motor problems were related to VCR dose. METHODS.In 128 children ages 4 -12 years who completed treatment after at least 1 year, motor performance was measured using the Movement Assessment Battery for Children (m-ABC). RESULTS.The m-ABC scores of the total study group were significantly lower than those of the normal population (P Ͻ 0.001). There were no differences in scores noted between children with ALL, WT, B-NHL, or MMT. There also were no differences noted between those children with ALL who had received pulses of VCR and steroids during maintenance therapy and those who had not. All groups demonstrated large variability in scores. Scores were not found to be significantly different between those children who had received low (Ͻ 20 mg/m 2 ), intermediate (20 -40 mg/m 2 ), or high (Ͼ 40 mg/m 2 ) cumulative doses of VCR. Cumulative doses of corticosteroids and methotrexate did not affect scores, nor did age at diagnosis and time since the completion of therapy. CONCLUSIONS.Although motor performance was impaired in all patient groups, no correlation was found between motor performance and the cumulative dose of VCR or other drugs, age, and follow-up time. Future studies have to address several issues, including whether polymorphisms in drug metabolizing genes or drug target genes explain the significant variability noted in the long-term motor outcome of children with cancer.

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Avascular necrosis of bone following an intensified chemotherapy regimen including high dose steroids

Cited by 37 publications

References 13 publications

Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

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

Decrease in motor performance in children with cancer is independent of the cumulative dose of vincristine

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