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

Abstract

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.

Osteonecrosis in children with acute lymphoblastic leukemia

“…8 As the earlier reports were based on retrospective data collection, the true osteonecrosis incidence was most likely underestimated. However, 6 of the 17 affected patients reported by Ribeiro et al 33 and 16 of the 23 patients reported by Niinimäki et al 8 were only detected by MRI, and the patients remained asymptomatic until the end of the study. Two independent retrospective reports on BerlinFrankfurt-Muenster (BFM)-based trials with quite similar therapy (AIEOP-ALL 95, 34 ALL-BFM 95 10 ) from the late 90s determined a much lower, but almost identical, osteonecrosis incidence of 1.6-1.8%.…”

“…A magnetic resonance imaging (MRI) screening based prospective study determined a significantly higher osteonecrosis incidence (15.5%) without the impact of steroid dose or dexamethasone administration (see Table 4). 33 This was even exceeded by a prospective study analyzing the Nordic ALL protocols, which reported an osteonecrosis incidence as high as 24%, identified by MRI screening at the end of treatment. 8 As the earlier reports were based on retrospective data collection, the true osteonecrosis incidence was most likely underestimated.…”

Impaired dexamethasone-related increase of anticoagulants is associated with the development of osteonecrosis in childhood acute lymphoblastic leukemia

“…For this study we aimed to investigate clinical relevant symptomatic ON. 17 Symptomatic ON was defined as persistent pain in the arms or legs not associated with recent vincristine administration, in combination with typical findings on magnetic resonance imaging(MRI). 18 Peripheral-blood samples were taken at diagnosis and at five time points (days 29, 33, 36, 40 and 43) during induction therapy of ALL (Figure 1).…”

Secretion of angiogenic proteins by human multipotent mesenchymal stromal cells and their clinical potential in the treatment of avascular osteonecrosis

“…6,7 Correlation of imaging results with clinical symptoms such as pain, reduced mobility or immobilization is even more difficult in children. 8 Current treatment strategies aim primarily at elimination of pain, restoration of function and prevention of disease progression. Conservative measures are limited to immobilization and physiological rehabilitation, which is often complicated in children due to compliance problems.…”