Osteonecrosis in children with acute lymphoblastic leukemia at initial diagnosis and prior to any chemotherapy

Abstract

Osteonecrosis (ON) is a common and debilitating side effect of anti-leukemic treatment in children with acute lymphoblastic leukemia (ALL). However, the impact of leukemia itself on ON development remains elusive. We analyzed 76 children enrolled in the ongoing OPAL trial, who had magnetic resonance imaging (MRI) studies at diagnosis. MRI screening revealed 14 osteonecrotic lesions (5 × hips, 9 × knees) of any grade (I–III) in 7 (9.2%) patients. Six months on, the number of ON per patient increased (1 patient), remained constant (2), and decreased (2). The severity increased from grade I to II in two patients, remained constant (1), completely resolved (2), and decreased from grade III to osteoedema (1). No differences between adolescents initially presenting with/without ON were observed concerning age, pubertal stage, body mass index, leukemia characteristics, and clinical presentation. In MRI screening, a remarkable number of adolescents with ALL present with ON at diagnosis. The course of these ON remains highly unpredictable.

Keywords:

• Osteonecrosis
• ALL
• leukemia
• diagnosis
• adolescents
• MRI screening

Acknowledgements

The authors thank Mrs. Ulrike Richter for assistance in data management. We thank the patients and families, who participated in this trial, the physicians and nurses of all hospitals for their contribution.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2018.1466292.

Additional information

Funding

This work was supported by the German Childhood Cancer Foundation under Grant DKS 2011.11.