Osteonecrosis in pediatric patients with acute lymphoblastic leukemia

✍ Scribed by Ronald G. Murphy; Mark L. Greenberg

• Publisher: John Wiley and Sons
• Year: 1990
• Tongue: English
• Weight: 403 KB
• Volume: 65
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/1097-0142(19900415)65:8<1717::aid-cncr2820650809>3.0.co;2-b

✦ Synopsis

The authors report five pediatric patients with acute lymphoblastic leukemia (ALL) in whom symptomatic aseptic osteonecrosis developed on therapy. All patients had been on treatment with a modified BFM protocol and developed osteonecrosis in the maintenance phase of the protocol. The avascular necrosis was multifocal in all. The authors' data suggest that dexamethasone used in the reinduction phase of the protocol may be the responsible agent although no definite proof exists. Since only symptomatic patients are reported, the true frequency of this complication may be significantly higher. Cancer 65~717-1721,1990.

VASCULAR NECROSIS OF BONE (AVN) may occur as

A a complication of several disorders.' It has been associated with corticosteroid administration of both shortterm and long-term d ~r a t i o n . ~, ~ Its occurrence in malignant disease such as lymphoma has been well de~cribed.~.' However, it has rarely been reported as a complication of acute lymphoblastic leukemia (ALL) or its

We describe five patients with ALL in whom this complication presented clinically. Three patients incurred severe disability.

Patients

A recent review of all patients treated for ALL in our institution in the period 1983 through 1987 revealed a total of 228 patients. Of these, 113 were categorized as high risk and assigned to a treatment regime based on a modified BFM protocol. Five of these (4.4%) developed symptomatic avascular osteonecrosis while on treatment.

The modified BFM protocol is an intensive combined modality, multiphase regime. The protocol consists of induction, central nervous system prophylaxis/consolidation, interim maintenance, reinduction-reintensification, and maintenance phases. It includes 28 days of prednisone at a dose of 60 mg/m2 per day in the induction phase and 4 weeks of dexamethasone at a dose of 10 mg/m2 per day