Mallorie B Heneghan1, Susan R Rheingold2, Yimei Li3, Alix E Seif2, Yuan-Shung Huang4, Lisa McLeod5, Lawrence Wells6, Brian T Fisher7, Richard Aplenc8. 1. Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: Heneghanm@email.chop.edu. 2. Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA. 3. Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA. 4. Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 5. Pediatric Hospital Medicine, Children's Hospital of Colorado. 6. Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA. 7. Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA. 8. Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA.
Abstract
BACKGROUND: Cure rates for acute lymphoblastic leukemia (ALL) have improved, but as therapy has intensified, the burden of osteonecrosis (ON) has increased. Limited data exist regarding surgical interventions for pediatric ALL patients with ON. MATERIALS AND METHODS: A multi-center cohort of children with newly diagnosed ALL was established with Pediatric Health Information System (PHIS) data from 43 freestanding children's hospitals from 1999 to 2011. Patients with ON identified by International Classification of Diseases, Ninth Revision (ICD-9) code were followed for up to 5 years after index ALL admission for the presence of ON-associated orthopedic surgical procedures. RESULTS: A cohort of 10,729 ALL patients was assembled, of which 242 (2.33%) were identified with an ICD-9 code for ON within 5 years of ALL diagnosis. Fifty-five patients (22.7%) with ON underwent orthopedic surgical intervention aimed at joint preservation (82%) or replacement (18%) with substantial practice variation by hospital in both the rate and type of surgical intervention. The majority of patients had surgical procedures while receiving maintenance therapy. None of the patients undergoing surgical intervention required intensive care unit-level care within 14 days of surgery, and there was no associated in-hospital mortality. CONCLUSIONS: No standard of care exists for treatment of ALL-associated ON. While considerable practice variation exists, surgical intervention appears relatively safe.
BACKGROUND: Cure rates for acute lymphoblastic leukemia (ALL) have improved, but as therapy has intensified, the burden of osteonecrosis (ON) has increased. Limited data exist regarding surgical interventions for pediatric ALL patients with ON. MATERIALS AND METHODS: A multi-center cohort of children with newly diagnosed ALL was established with Pediatric Health Information System (PHIS) data from 43 freestanding children's hospitals from 1999 to 2011. Patients with ON identified by International Classification of Diseases, Ninth Revision (ICD-9) code were followed for up to 5 years after index ALL admission for the presence of ON-associated orthopedic surgical procedures. RESULTS: A cohort of 10,729 ALL patients was assembled, of which 242 (2.33%) were identified with an ICD-9 code for ON within 5 years of ALL diagnosis. Fifty-five patients (22.7%) with ON underwent orthopedic surgical intervention aimed at joint preservation (82%) or replacement (18%) with substantial practice variation by hospital in both the rate and type of surgical intervention. The majority of patients had surgical procedures while receiving maintenance therapy. None of the patients undergoing surgical intervention required intensive care unit-level care within 14 days of surgery, and there was no associated in-hospital mortality. CONCLUSIONS: No standard of care exists for treatment of ALL-associated ON. While considerable practice variation exists, surgical intervention appears relatively safe.
Authors: Mariël L te Winkel; Rob Pieters; Wim C J Hop; Hester A de Groot-Kruseman; Maarten H Lequin; Inge M van der Sluis; Jos P M Bökkerink; Jan A Leeuw; Marrie C A Bruin; R Maarten Egeler; Anjo J P Veerman; Marry M van den Heuvel-Eibrink Journal: J Clin Oncol Date: 2011-09-26 Impact factor: 44.544
Authors: Mariël L Te Winkel; Rob Pieters; Ernst-Jan D Wind; J H J M Gert Bessems; Marry M van den Heuvel-Eibrink Journal: Haematologica Date: 2014-03 Impact factor: 9.941
Authors: David R Marker; Thorsten M Seyler; Slif D Ulrich; Siddharth Srivastava; Michael A Mont Journal: Clin Orthop Relat Res Date: 2008-04-08 Impact factor: 4.176
Authors: Lawrence Wells; Harish S Hosalkar; Eileen A Crawford; Nina Agrawal; Jennifer Goebel; John P Dormans Journal: J Pediatr Orthop Date: 2009-06 Impact factor: 2.324
Authors: Nina S Kadan-Lottick; Irina Dinu; Karen Wasilewski-Masker; Sue Kaste; Lillian R Meacham; Anita Mahajan; Marilyn Stovall; Yutaka Yasui; Leslie L Robison; Charles A Sklar Journal: J Clin Oncol Date: 2008-06-20 Impact factor: 50.717
Authors: Nadia Amin; Sally Kinsey; Richard Feltbower; Jeannette Kraft; Elizabeth Whitehead; Mark Velangi; Beki James Journal: BMJ Open Date: 2019-05-22 Impact factor: 2.692