Avascular necrosis of bone after adult acute lymphocytic leukemia treatment with methotrexate, vincristine, L-asparaginase, and dexamethasone (MOAD).

Four of 55 (7%) adult acute lymphocytic leukemia patients, age 27-58 years, who were treated with methotrexate, vincristine, L-asparaginase, and dexamethasone (MOAD) developed avascular necrosis (AVN) of one or both femoral heads 16-39 months after beginning treatment. All patients were treated with total joint replacement without compromise of quality of life during more than 3-9 years of follow-up, and they have remained in complete remission for a total of 6.5 + to 10.5 + years. A review of the literature revealed 11 previously reported cases of AVN of bone in patients with acute lymphocytic leukemia, 10 of whom received dexamethasone. The patients in the present report received a total dexamethasone dose equivalent to that of prednisone, 3.4-5.0 g/M2. Although AVN of bone has been reported in patients receiving chemotherapy without corticosteroids, corticosteroids appear to be the most common class of agents associated with its development, and dexamethasone treatment may be more likely to result in AVN of bone than other corticosteroids, for unknown reasons.