Bone marrow magnetic resonance studies in childhood leukemia. Evaluation of osteonecrosis

Abstract

In 25 patients under treatment or during follow-up for acute lymphoblastic leukemia magnetic resonance imaging (MRI) of both knees was compared to history and physical examination to detect osteonecrosis. Results of MRI were classified as: 0, normal bone marrow (BM); 1, diffuse decrease in signal intensity; 2, circumscript lesions. Patients clinically suspected of osteonecrosis had a statistically significant increased incidence of Type 2 lesions. Three patients with a BM relapse also showed Type 2 lesions. Circumscript lesions of the epiphyses were seen exclusively in the four patients with clinical suspicion of osteonecrosis during B M remission and this may be a MR finding strongly indicative of osteonecrosis. Patients with Type 2 lesions during BM remission had received systemic chemotherapy for a statistically significant longer period than the other patients. Using MRI findings we suspect that at least four patients suffered osteonecrosis due to chemotherapy. MRI is a promising means of detecting this disorder.Cancer 60:2994-3000. 1987.HILDREN with acute lymphoblastic leukemia C (ALL) treated with combined chemotherapy sometimes complain of bone or joint pain. This may be due to osteonecrosis. In the literature this is often referred to as avascular necrosis of bone. Many case reports of this complication in patients with leukemia have been published.'-I6 However, the frequency of osteonecrosis in children with ALL is unknown. The reported percentages vary from 3% to 85% depending on the population studied and the time and method of diagnosis. 17-20

Bone mineral density and osteonecrosis in survivors of childhood allogeneic bone marrow transplantation

“…In the early stages, patients are treated with nonweight-bearing activities such as swimming to maintain joint function and to control body weight. 14,49 At more advanced stages, surgical intervention (ie core decompression, arthroplasty, or total joint replacement) may be necessary to ameliorate symptoms and preserve joint function. 14,49 Using multivariate analysis, investigators at the University of Minnesota identified increasing age at the time of BMT (P ¼ 0.002), acute or chronic GVHD requiring steroid therapy (P ¼ 0.003) as significant and independent risk factors for developing osteonecrosis after allogeneic transplantation in 28 (4%) of 642 consecutive patients ranging in age from 1.5 to 47 years (median, 26 years) at the time of BMT.…”

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

“…Harper et al published work in the 1980s suggesting that chemotherapy agents alone may be responsible in the pathophysiology of avascular necrosis of the femoral head, amongst other sites. 4 Several studies have linked osteonecrosis to the UKALL treatment regime for ALL, [5][6][7][8] which was used in this case. Is it possible that the SCFE occurred due to an iatrogenic shift of physeal physiology at an age where the physis widens and periosteum thins 9 within 3 weeks following chemosteroidal treatment, both of which being implicated in the literature in the pathogenesis of ON.…”

Aggravated bone density decline following symptomatic osteonecrosis in children with acute lymphoblastic leukemia

“…30,31 From here on, we refer to symptomatic osteonecrosis as ON. ON was graded according to the National Cancer Institute (NCI) Common Terminology criteria for Adverse Events, version 3.0.…”