Riitta Niinimäki1, Lene Mølgaard Hansen2, Tuukka Niinimäki3, Jørgen H Olsen4, Tytti Pokka1, Risto Sankila5, Kim Vettenranta6, Henrik Hasle2, Arja Harila-Saari1. 1. Department of Pediatrics, Oulu University Hospital , Oulu, Finland . 2. Department of Pediatrics, Aarhus University Hospital , Aarhus, Denmark . 3. Department of Surgery, Oulu University Hospital , Oulu, Finland . 4. Danish Cancer Society, Institute of Cancer Epidemiology , Copenhagen, Denmark . 5. Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research , Helsinki, Finland . 6. Division of Hematology-Oncology and Stem Cell Transplantation, Department of Pediatrics, Helsinki University Central Hospital , Helsinki, Finland .
Abstract
Purpose: The population-based incidence of severe osteonecrosis (ON) necessitating total joint arthroplasty (TJA) in patients with hematological cancer is unknown. This study assessed the incidence of ON requiring primary TJA in children and young adults treated for leukemia or lymphoma. Methods: Patients diagnosed with leukemia or lymphoma before 31 years of age were identified from the Finnish and Danish Cancer Registries. These data were combined with those from the National Hospital Discharge and the Finnish Arthroplasty Registers. Data on the orthopedic procedures performed and the appropriate diagnosis codes given before the age of 40 were also retrieved. Results: The estimated cumulative incidence of TJA was 4.5% at 20 years for patients treated for chronic myeloid leukemia, followed by 2.1% for patients treated for acute myeloid leukemia. It was considerably lower in patients with acute lymphoblastic leukemia (ALL; 0.4%). Multivariate analysis revealed that allogeneic stem cell transplantation (allo-SCT) increased the risk of TJA (hazard ratio [HR]=9.4; 95% CI: 5.3-16.9). The risk of TJA was higher in patients diagnosed with cancer at 10-19 and 20-30 years of age than in those diagnosed before the age of 10 (HR=24; 95% CI: 3.1-176 and HR=26; 95% CI: 3.6-192 respectively). Conclusion: The incidence of ON requiring TJA was highest among patients with myeloid leukemias and lowest in patients treated for ALL. Allo-SCT and age ≥10 years at diagnosis were the most important risk factors for ON requiring TJA in hematological malignancies.
Purpose: The population-based incidence of severe osteonecrosis (ON) necessitating total joint arthroplasty (TJA) in patients with hematological cancer is unknown. This study assessed the incidence of ON requiring primary TJA in children and young adults treated for leukemia or lymphoma. Methods:Patients diagnosed with leukemia or lymphoma before 31 years of age were identified from the Finnish and Danish Cancer Registries. These data were combined with those from the National Hospital Discharge and the Finnish Arthroplasty Registers. Data on the orthopedic procedures performed and the appropriate diagnosis codes given before the age of 40 were also retrieved. Results: The estimated cumulative incidence of TJA was 4.5% at 20 years for patients treated for chronic myeloid leukemia, followed by 2.1% for patients treated for acute myeloid leukemia. It was considerably lower in patients with acute lymphoblastic leukemia (ALL; 0.4%). Multivariate analysis revealed that allogeneic stem cell transplantation (allo-SCT) increased the risk of TJA (hazard ratio [HR]=9.4; 95% CI: 5.3-16.9). The risk of TJA was higher in patients diagnosed with cancer at 10-19 and 20-30 years of age than in those diagnosed before the age of 10 (HR=24; 95% CI: 3.1-176 and HR=26; 95% CI: 3.6-192 respectively). Conclusion: The incidence of ON requiring TJA was highest among patients with myeloid leukemias and lowest in patients treated for ALL. Allo-SCT and age ≥10 years at diagnosis were the most important risk factors for ON requiring TJA in hematological malignancies.
Authors: Jitesh D Kawedia; Sue C Kaste; Deqing Pei; John C Panetta; Xiangjun Cai; Cheng Cheng; Geoffrey Neale; Scott C Howard; William E Evans; Ching-Hon Pui; Mary V Relling Journal: Blood Date: 2010-12-10 Impact factor: 22.113
Authors: Elena J Ladas; Manuela Orjuela; Kristen Stevenson; Peter D Cole; Meiko Lin; Uma H Athale; Luis A Clavell; Jean-Marie Leclerc; Bruno Michon; Marshall A Schorin; Jennifer Greene Welch; Barbara L Asselin; Stephen E Sallan; Lewis B Silverman; Kara M Kelly Journal: Nutrition Date: 2016-03-28 Impact factor: 4.008