Osteonecrosis in children treated for acute lymphoblastic leukemia

Ojala, A; Lanning, F. P.; Pääkkö, Eija; Lanning, B. Marjatta

doi:10.1002/(sici)1096-911x(199710)29:4<260::aid-mpo5>3.0.co;2-k

Cited by 47 publications

(40 citation statements)

References 27 publications

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“…There was no attempt to differentiate between early and chronic osteonecrotic lesions based on signal intensity. Lesions that showed bone edema only without the typical rim for osteonecrosis (giving an appearance of decreased signal intensity with poorly defined margins on T1-weighted imaging) were excluded from the definition of osteonecrosis, as they can be seen with multiple other bone conditions, including bone marrow contusion, ischemia, and microfractures [14,20,21]. Rather, such lesions were called patchy according to a previously published definition [21] and were reported separately.…”

Section: Methodsmentioning

confidence: 99%

“…With the clinical focus shifting toward minimizing morbidity of treatment while maintaining remission rates, osteonecrosis is progressively recognized as an important source of morbidity in survivors of ALL, with published prevalence rates between 1% and 65% [15,16,20]. Osteonecrosis is increasingly linked to systemic corticosteroids in chemotherapy protocols [7], and it has become clear many patients with ALL with osteonecrosis have multisite lesions, of which as much as 55% can be asymptomatic [12] .…”

Section: Introductionmentioning

confidence: 99%

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Widespread Osteonecrosis in Children With Leukemia Revealed by Whole-body MRI

Miettunen

Lafay‐Cousin

Guilcher

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Widespread Osteonecrosis in Children With Leukemia Revealed by Whole-body MRI

Miettunen

Lafay‐Cousin

Guilcher

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…[10]. One series using routine MRI of the lower extremities of children treated for ALL revealed an incidence of ON of 38% (in all locations) [9]. Frequency of symptomatic ON in any location reportedly is greater among adolescents and patients receiving higher doses of dexamethasone, and reportedly is as much as 21% in some age groups [8].…”

Section: Introductionmentioning

confidence: 99%

How Does Osteonecrosis About the Knee Progress in Young Patients with Leukemia?: A 2- to 7-year Study

Karimova¹,

Wozniak

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Osteonecrosis is a major treatment complication of pediatric leukemias owing to its potential to cause joint deterioration. Because of potential long-term effects of osteonecrosis on joints, information regarding its progression and collapse in different patients can be used to identify high-risk groups, advise the patients and parents of this complication, and potentially consider the risk for development of osteonecrosis in planning primary treatment. Questions/purposes We therefore determined: (1) the incidence of joint collapse and/or pain in young patients with hematologic malignancies diagnosed with ON of the knee; (2) risk factors associated with collapse; and (3) the relationship between size and location of osteonecrotic knee lesions and the likelihood of joint collapse. Patients and Methods We retrospectively reviewed 109 patients with hematologic malignancies and MRI-confirmed knee osteonecrosis. The median age was 11.5 years (range, 2.3-18.8 years) at primary diagnosis of hematologic malignancy and a median age of 13.4 years (range, 2.7-23.3 years) at diagnosis of osteonecrosis of the knee. For analyses, we used the first and last MR images. Minimum clinical followup was 2.3 years after diagnosis of knee osteonecrosis (median, 6 years; range, 2.3-7.17 years).

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“…This is confirmed in our study where the femoral head is involved in three cases and the humerus head only in one. 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.…”

Section: Discussionmentioning

confidence: 99%

“…In regards to the chemotherapy used in ALL patients, the incidence of symptomatic ON is reported in a variable percentage from 4 to 38% in retrospective and prospective studies. 4,9 The symptomatology of ON after chemotherapy can be extremely variable and switch between a virtual absence of symptoms to a very disabling condition combining pain, loss of musculoskeletal function and variable joint damage. 10 Symptomatic ON after chemotherapy is commonly multifocal and bilateral and involving joints in constant load, such as hip and knee, are generally the most affected and almost never asymptomatic.…”

Section: Introductionmentioning

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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Osteonecrosis in children treated for acute lymphoblastic leukemia

Cited by 47 publications

References 27 publications

Widespread Osteonecrosis in Children With Leukemia Revealed by Whole-body MRI

Widespread Osteonecrosis in Children With Leukemia Revealed by Whole-body MRI

How Does Osteonecrosis About the Knee Progress in Young Patients with Leukemia?: A 2- to 7-year Study

Osteonecrosis as a complication in pediatric patients with acute lymphoblastic leukemia

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