Avascular Necrosis of the Femoral Head in Neuroblastoma: A Case Report

Narayanan, Geetha; Nb, Dip; Kumary, P. Kusuma; K, Ramachandran; Nair, Manjusha

doi:10.3109/08880019809016574

Cited by 7 publications

(3 citation statements)

References 8 publications

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“…However, there are also a few reports of HR-NBL patients with osteonecrosis. [32][33][34] Both our HR-NBL survivors with osteonecrosis had received TBI, and the other had undergone kidney transplantation, that probably played the main role in the pathogenesis of osteonecrosis in that patient.…”

Section: Factormentioning

confidence: 99%

Skeletal outcome in long-term survivors of childhood high-risk neuroblastoma treated with high-dose therapy and autologous stem cell rescue

Utriainen

Vatanen

Toiviainen-Salo

et al. 2017

Bone Marrow Transplant

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High-dose therapy and hematopoietic stem cell transplantation (HSCT) have been shown to improve survival rates in high-risk neuroblastoma (HR-NBL), but may cause adverse effects on the growing skeleton. We studied skeletal health in a national cohort of long-term survivors of HR-NBL (n=21; age 16-30 years, median 22 years) and in 20 healthy age- and sex-matched controls. In addition to clinical evaluation and measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry, we performed spinal magnetic resonance imaging. Skeletal complications were categorized according to Common Terminology Criteria for Adverse Events (CTCAE). Altogether, 18/21 survivors presented with at least one skeletal adverse event according to CTCAE, the most common skeletal complications being short stature (n=14) and osteopenia (n=13). Altogether, 38% of the subjects had a severe complication (CTCAE score ⩾3) including bilateral slipped capital femoral epiphyseolysis in 3/21. Fracture rate was not increased. In spinal MRI, no vertebral fractures were found and degenerative intervertebral disc changes were equally prevalent in survivors and controls. BMD was lower in survivors than controls, but differences became non-significant when adjusted for bone size. In conclusion, skeletal late complications are common and can significantly impair the quality of life in young adult survivors of HR-NBL treated with high-dose protocols and HSCT.

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Section: Factormentioning

confidence: 99%

Skeletal outcome in long-term survivors of childhood high-risk neuroblastoma treated with high-dose therapy and autologous stem cell rescue

Utriainen

Vatanen

Toiviainen-Salo

et al. 2017

Bone Marrow Transplant

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“…Despite this well‐recognized association, an unequivocal casual relation between steroid exposure and ON has not been established (Gebhard & Maibach, 2001). ON has been reported at diagnosis of ALL, prior to steroid treatment (Gurkan et al , 2006), and occurs in a variety of haematological and non‐haematological cancers that are not treated with steroids, including acute promyelocytic leukaemia (Abhyankar et al , 2000), acute and chronic myeloid leukaemia (Joseph et al , 2006; Ghosh et al , 2008) and neuroblastoma (Geetha et al , 1998). Short‐term use of steroids in the absence of other risk factors is associated with a negligible risk of ON.…”

Section: Aetiologymentioning

confidence: 99%

Management of osteonecrosis in children and young adults with acute lymphoblastic leukaemia

Vora

2011

Br J Haematol

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Summary Osteonecrosis is a disabling complication in children and young adults with acute lymphoblastic leukaemia. It can affect any or multiple joints but the hip and knee are most frequently involved and a cause of long‐term disability. The problem is almost exclusively that of older children and young adults of whom over 70% have asymptomatic changes on screening magnetic resonance imaging and 15–20% have resulting symptoms. Dexamethasone is associated with a higher risk than prednisolone in US but not European or UK trials and alternate week scheduling of dexamethasone in the intensification course is associated with a lower risk than a continuous 3‐week schedule in US trials. Genetic factors and obesity contribute to the risk, as do metabolic abnormalities caused by drugs, such as asparaginase, which increase tissue exposure to steroids. Management is primarily supportive but a minority of patients require surgical intervention including replacement of the affected joint. A variety of surgical techniques and, latterly, bisphophonates, have been tried to prevent progression but their efficacy remains uncertain. Whether patients should continue to receive steroids after diagnosis of osteonecrosis is uncertain but most trial investigators recommend stopping them after completion of the intensification phase of treatment.

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“…Bernbeck et al 6 described a child with nephroblastoma who developed ON, and 2 case reports of children with neuroblastoma and ON have also been published. 7,8 Incidence rates vary widely, depending on the imaging methods used for the diagnosis of ON and the differences in treatment. Magnetic resonance imaging (MRI) has been established as the most sensitive method in the early diagnosis of ON.…”

mentioning

confidence: 99%