PURPOSE: The aim of the study was to determine the incidence of and clinical risk factors for radiographic osteonecrosis (ON) in children treated for acute lymphoblastic leukemia (ALL) using the Nordic ALL protocols. PATIENTS AND METHODS: Ninety-seven consecutive patients with childhood ALL were studied prospectively by magnetic resonance imaging (MRI) of the lower extremities at the end of the treatment. RESULTS: Twenty-three (24%) of the 97 patients had ON. Seven of the patients (30%) were symptomatic, and three patients (13%) required surgical interventions. Multiple logistic regression analysis showed that high body mass index (BMI; P = .04), female sex (P = .01), older age at diagnosis (P < .001), and higher cumulative dexamethasone dose (P = .03) were independent risk factors for radiographic ON. The cumulative prednisone dose did not differ significantly between the patients with and without ON. The incidence of radiographic ON decreased significantly, from 36% to 7%, when the duration of dexamethasone exposure during the delayed-intensification phase was shortened from 3 to 4 weeks to 2 weeks with a taper (P = .001). CONCLUSION: ON as determined by MRI was found to be a common complication in children and adolescents after treatment with the Nordic ALL protocols. Revision of the ALL protocols by shortening the single exposure to dexamethasone has diminished the risk for ON remarkably. High BMI was identified as a new significant risk factor for ON.
PURPOSE: The aim of the study was to determine the incidence of and clinical risk factors for radiographic osteonecrosis (ON) in children treated for acute lymphoblastic leukemia (ALL) using the Nordic ALL protocols. PATIENTS AND METHODS: Ninety-seven consecutive patients with childhood ALL were studied prospectively by magnetic resonance imaging (MRI) of the lower extremities at the end of the treatment. RESULTS: Twenty-three (24%) of the 97 patients had ON. Seven of the patients (30%) were symptomatic, and three patients (13%) required surgical interventions. Multiple logistic regression analysis showed that high body mass index (BMI; P = .04), female sex (P = .01), older age at diagnosis (P < .001), and higher cumulative dexamethasone dose (P = .03) were independent risk factors for radiographic ON. The cumulative prednisone dose did not differ significantly between the patients with and without ON. The incidence of radiographic ON decreased significantly, from 36% to 7%, when the duration of dexamethasone exposure during the delayed-intensification phase was shortened from 3 to 4 weeks to 2 weeks with a taper (P = .001). CONCLUSION: ON as determined by MRI was found to be a common complication in children and adolescents after treatment with the Nordic ALL protocols. Revision of the ALL protocols by shortening the single exposure to dexamethasone has diminished the risk for ON remarkably. High BMI was identified as a new significant risk factor for ON.
Authors: Vincent Gagné; Anne Aubry-Morin; Maria Plesa; Rachid Abaji; Kateryna Petrykey; Pascal St-Onge; Patrick Beaulieu; Caroline Laverdière; Nathalie Alos; Jean-Marie Leclerc; Stephen E Sallan; Donna Neuberg; Jeffery L Kutok; Lewis B Silverman; Daniel Sinnett; Maja Krajinovic Journal: Pharmacogenomics Date: 2019-11-05 Impact factor: 2.533
Authors: Justine M Kahn; Peter D Cole; Traci M Blonquist; Kristen Stevenson; Zhezhen Jin; Sergio Barrera; Randy Davila; Emily Roberts; Donna S Neuberg; Uma H Athale; Luis A Clavell; Caroline Laverdiere; Jean-Marie Leclerc; Bruno Michon; Marshall A Schorin; Jennifer J G Welch; Stephen E Sallan; Lewis B Silverman; Kara M Kelly Journal: Pediatr Blood Cancer Date: 2017-11-01 Impact factor: 3.167
Authors: Emily R Finch; Laura J Janke; Colton A Smith; Seth E Karol; Deqing Pei; Cheng Cheng; Sue C Kaste; Hiroto Inaba; Ching-Hon Pui; Joshua Wolf; Mary V Relling Journal: Pediatr Blood Cancer Date: 2019-02-13 Impact factor: 3.167
Authors: Stephanie W Mayer; Braden K Mayer; J Mack Aldridge; James R Urbaniak; Robert D Fitch; Robert K Lark Journal: J Child Orthop Date: 2012-12-25 Impact factor: 1.548