Comparing osteonecrosis clinical phenotype, timing, and risk factors in children and young adults treated for acute lymphoblastic leukemia

• Published in: Pediatric blood & cancer 2018-10, Vol.65 (10), p.e27300-n/a
• Main Authors: Mogensen, Signe Sloth, Harila‐Saari, Arja, Mäkitie, Outi, Myrberg, Ida Hed, Niinimäki, Riitta, Vestli, Anne, Hafsteinsdottir, Solveig, Griškevicius, Laimonas, Saks, Kadri, Hallböök, Helene, Retpen, Jens, Helt, Louise Rold, Toft, Nina, Schmiegelow, Kjeld, Frandsen, Thomas Leth
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Adolescents; Age; Children; Dexamethasone; Diagnosis; Females; Hematology; Leukemia; Lymphatic leukemia; Males; Medicin och hälsovetenskap; Oncology; Osteonecrosis; Pain; Patients; Pediatrics; phenotype; Phenotypes; Risk factors; Teenagers; Young adults
• ISSN: 1545-5009; 1545-5017; 1545-5017
• DOI: 10.1002/pbc.27300

Background Treatment‐related osteonecrosis (ON) is a serious complication of treatment of acute lymphoblastic leukemia (ALL). Procedure This study included 1,489 patients with ALL, aged 1–45 years, treated according to the Nordic Society of Paediatric Haematology and Oncology ALL2008 protocol, using alternate‐week dexamethasone during delayed intensification, with prospective registration of symptomatic ON. We aimed at comparing risk factors, timing, and clinical characteristics of ON in children and young adults. Results ON was diagnosed in 67 patients, yielding a 5‐year cumulative incidence of 6.3%, but 28% in female adolescents. Median age at ALL diagnosis was 12.1 years and 14.9 years for females and males, respectively. At ON diagnosis, 59 patients had bone pain (91%) and 30 (46%) had multiple‐joint involvement. The median interval between ALL and ON diagnosis was significantly shorter in children aged 1.0–9.9 years (0.7 years [range: 0.2–2.1]) compared with adolescents (1.8 years [range: 0.3–3.7, P