Aseptic osteonecrosis in children with acute lymphoblastic leukemia.

Joint destruction caused by aseptic osteonecroses (AONs) is a severe complication in acute lymphoblastic leukemia (ALL). Here, factors were determined that influence the occurrence and clinical course of AON in ALL patients. Clinical data of 121 patients were correlated with the occurrence of AON. Magnetic resonance imaging was performed in patients with bone pain. Areas of AONs were correlated with the clinical course of AON. Ten patients presented with clinical symptoms of AON and 9 of 10 patients were graded as high-risk ALL compared with 46 of 111 patients without AON (chi 2, P < .05). In 10 ALL patients 66 AONs were identified by MRI. In some patients up to 14 different AON sites were observed. The courses of AONs varied in individual patients, suggesting that necrosis-specific factors might be responsible. A size above 900 mm2 was significantly associated with progressive AON (P < .01). The more intensive treatment regimen in high-risk ALL patients might contribute to the development of AON. The clinical course of AON, however, is determined by necrosis-specific factors such as a large size. These data could help in developing therapeutic strategies for the prevention of progressive AON.