Osteonecrosis: A treatment related toxicity in childhood acute lymphoblastic leukemia (ALL)—experiences from trial ALL‐BFM 95

“…Another controversial point of discussion concerns the type of Ojala and co-workers have reported a cure rate with restitutio ad integrum in approximately 30% of patients, 9 while other multi-center studies have shown that approximately 22-24% of symptomatic patients have undergone at least one orthopedic surgery. 15,23 Currently, in severe and rapidly progressive osteonecrosis, a surgical approach is commonly accepted, associated with no weight bearing and physical exercises. In patients with osteonecrosis, smaller lesions and fewer symptoms, the therapeutic approach is generally more conservative, essentially based on the absolute prohibition of loading and active and passive physiotherapy in open kinetic chain.…”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis as a complication in pediatric patients with acute lymphoblastic leukemia

et al. 2016

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Osteonecrosis is a significant adverse effect of treatment administered to children suffering from acute lymphoblastic leukemia (ALL) that may have a negative effect on the quality of life. The purpose of this study is to evaluate the rate of secondary vascular osteonecrosis (ON) in a population of pediatric patients with ALL treated with corticosteroids and cytostatic agents. A retrospective analysis of prospectively collected data of the medical records of 328 patients with ALL identified 4 cases with ON, corresponding to 1.2% of all cases observed. Of the 4 patients identified in our study 3 were girls and 1 was a boy, aged from 10 to 16 years old (average age at diagnosis, 12 years). Median time between the diagnosis of ALL and ON was 12.5 months (range, 12 to 36 months). Regarding the lesion size of ON, in all cases the femoral head (monolateral in 1 case and bilateral in 3 cases) was involved and was associated with the scapula-humeral joint in one case. ON of the weight-bearing joints has been identified as a severe complication in children with leukemia that may be associated with the development of articular surface collapse, subsequent debilitating arthritis, sometimes needing arthroplasty. For this reason it is very important to implement prevention strategies, especially in adolescent girls treated with steroids and chemotherapy. An early diagnosis of ON and careful orthopedic follow-up are necessary in order to avoid bone deformations related to the late start or the wrong therapy.

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“…In clinical practice, a dexamethasone dose ranging from 10 to 14 mg/m 2 is usually used [2,15,28]. In regard to the safety of corticosteroids, it has to be considered that corticosteroid treatment, especially in children older than 10 years, increases the risk of aseptic osteonecrosis [6,20,28]. Furthermore, laboratory studies suggest steroids may interfere with response to chemotherapy in osterosarcoma cell lines, but this has not been shown in vivo [9].…”

Section: Corticosteroidsmentioning

confidence: 99%

Antiemetics in children receiving chemotherapy. MASCC/ESMO guideline update 2009

Jordan¹,

Roila

Molassiotis

et al. 2010

Support Care Cancer

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Only a few studies have been carried out in children on the prevention of chemotherapy-induced nausea and vomiting (CINV). 5-HT 3 receptor antagonists have been shown to be more efficacious and less toxic than metoclopramide, phenothiazines and cannabinoids. Most dose studies are available for the 5-HT 3 receptor antagonists ondansetron and granisetron. The new 5-HT 3 receptor antagonist palonosetron was evaluated in one comparative study so far showing promising activity. Combinations of a 5-HT 3 receptor antagonist and dexamethasone showed increased efficacy with respect to a 5-HT 3 receptor antagonist alone. All paediatric patients receiving chemotherapy of high or moderate emetogenic potential should receive a combination of a 5-HT 3 receptor antagonist and dexamethasone to prevent acute emesis. No studies have specifically evaluated antiemetic drugs in the prevention of chemotherapy-induced delayed and anticipatory emesis in children. The role of the NK1 receptor antagonists in children has to be further investigated, although one small study is published so far, showing promising activity in the prevention of CINV with aprepitant. The new proposed guideline from the Multinational Association of Supportive Care in Cancer and the European Society of Clinical Oncology summarises the updated data from the literature and takes into consideration the existing guidelines.

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Osteonecrosis: A treatment related toxicity in childhood acute lymphoblastic leukemia (ALL)—experiences from trial ALL‐BFM 95

Abstract: Symptomatic ON is a rare event in patients treated with BFM-type chemotherapy with an overall 5-year cumulative incidence of 1.8%. The age group >/=10 years, and particularly adolescents >/=15 years have a significantly higher risk of developing ON.

Cited by 133 publications

References 17 publications

Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000

Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000

Osteonecrosis as a complication in pediatric patients with acute lymphoblastic leukemia

Antiemetics in children receiving chemotherapy. MASCC/ESMO guideline update 2009

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