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Chianca V, Lanckoroński M, Curti M, Chalian M, Sudoł-Szopińska I, Giraudo C, Del Grande F. Whole-Body Magnetic Resonance Imaging in Rheumatology. Radiol Clin North Am 2024; 62:865-876. [PMID: 39059977 DOI: 10.1016/j.rcl.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
This review focuses on the most frequent whole-body MRI applications in patients with rheumatological pathologies, for which this tool can be helpful to both radiologists and clinicians. It reports technical aspects of the acquisition of both 1.5 and 3.0 T scanners. The article lists the main findings that help radiologists during the evaluation of a specific pathology, both in the diagnostic phase and during follow-up.
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Affiliation(s)
- Vito Chianca
- Istituto di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, Lugano 6900 Switzerland.
| | - Michał Lanckoroński
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartanska 1 Street, Warsaw 02-637, Poland
| | - Marco Curti
- Istituto di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, Lugano 6900 Switzerland
| | - Majid Chalian
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartanska 1 Street, Warsaw 02-637, Poland
| | - Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - DCTV, University of Padova, Padova, Italy
| | - Filippo Del Grande
- Istituto di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, Lugano 6900 Switzerland; Facoltà di Scienze Biomediche, Università Della Svizzera Italiana, Via Buffi 13, Lugano 6900, Switzerland
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Brochu A, Kairy D, Alos N, Laverdière C, Sinnett D, Sultan S, Curnier D, Miron MC, El-Jalbout R, Fiscaletti M, Hébert LJ. Physical impairments, activity limitations, and participation restrictions of childhood acute lymphoblastic leukemia survivors with and without hip osteonecrosis: a PETALE cohort study. J Cancer Surviv 2024:10.1007/s11764-024-01585-4. [PMID: 38787491 DOI: 10.1007/s11764-024-01585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Long-term musculoskeletal complications represent a growing burden for survivors of childhood acute lymphoblastic leukemia (cALL). This study aimed to describe physical impairments, activity limitations, and participation restrictions in a high-risk subgroup of cALL survivors of the PETALE cohort. METHODS This cross-sectional study, using observational data from the PETALE cohort, included a subgroup of survivors who presented high-risk criteria for late effects. Outcomes measures consisted of hip magnetic resonance imaging, maximal isometric muscle strength (MIMS) or torque (MIMT), range of motion (ROM), Near Tandem Balance (NTB), 6-Minute Walk Test (6MWT), Five Time Sit-to-Stand Test (FTSST), and health-related quality of life. Descriptive statistics and regression analyses were performed. RESULTS Survivors (n = 97, 24.2 ± 6.7 years old) showed limited grip strength, FTSST, and NTB performance compared to reference values (p < 0.001). Thirteen participants (14.6%, 18 hips) had hip osteonecrosis (ON) (53.8% male). Higher severity hip ON was found in female survivors (66.7% vs. 22.2%). Survivors with hip ON had reduced hip external rotation ROM compared to those without (p < 0.05). Relationships were found between MIMS and ROM outcomes (r = 0.32, p < 0.01) and with 6MWT (r = 0.39-0.41, p < 0.001). Our multiple linear regression model explained 27.6% of the variance of the 6MWT. CONCLUSIONS Survivors in our subgroup had clinically significant physical impairments and activity limitations, and those with hip ON showed worst hip impairment outcomes. IMPLICATIONS FOR CANCER SURVIVORS These findings emphasize the importance of long-term follow-up including physical therapy assessment to help early identification and management of physical impairments and activity limitations in survivors of cALL.
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Affiliation(s)
- Annie Brochu
- CHU Sainte-Justine, Montréal, Canada.
- Université de Montréal, Montréal, Canada.
| | - Dahlia Kairy
- Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada
| | - Nathalie Alos
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Caroline Laverdière
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Daniel Sinnett
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Serge Sultan
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Daniel Curnier
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Marie-Claude Miron
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Ramy El-Jalbout
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Melissa Fiscaletti
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Luc J Hébert
- Université Laval, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, Canada
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Halton JM, Ma J, Babyn P, Matzinger MA, Kaste SC, Scharke M, Fernandez CV, Miettunen P, Ho J, Alos N, Abish S, Barr R, Cairney E, Dix DB, Grant RM, Israels S, Lewis V, Wilson B, Atkinson S, Cabral D, Cummings E, Rodd C, Stein R, Sbrocchi AM, Jaremko JL, Koujok K, Shenouda N, Rauch F, Siminoski K, Ward LM. Reductions in Bone Mineral Density Are Apparent Early in Children With Prevalent Osteonecrosis Lesions Following Leukemia Therapy. J Bone Miner Res 2023; 38:1104-1115. [PMID: 37326443 DOI: 10.1002/jbmr.4870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 06/17/2023]
Abstract
Osteonecrosis (ON) is a serious complication of childhood acute lymphoblastic leukemia. We determined the prevalence of osteonecrotic lesions in our patient population by a one-time multisite magnetic resonance imaging (MRI) more than 1 year following leukemia therapy. MRI findings were evaluated in relationship to clinical factors (including longitudinal changes in bone mineral density [BMD]). Eighty-six children enrolled in the Steroid Associated Osteoporosis in the Pediatric Population (STOPP) study were evaluated for ON at 3.1 ± 1.3 years following therapy. Thirty children had a total of 150 confirmed ON lesions (35%). Lumbar spine (LS) BMD Z-scores (mean ± SD) were low at diagnosis and similar between patients with and without ON (-1.09 ± 1.53 versus -1.27 ± 1.25, p = 0.549). LS BMD Z-scores declined from baseline to 12 months in children with ON (-0.31 ± 1.02) but not in those without (0.13 ± 0.82, p = 0.035); the hip BMD Z-scores from baseline to 24 months declined in both groups, but to a greater extent in those with ON (-1.77 ± 1.22) compared to those without (-1.03 ± 1.07, p = 0.045). At the time of the MRI, mean total hip and total body (TB) BMD Z-scores were lower in children with ON (hip -0.98 ± 0.95 versus -0.28 ± 1.06, p = 0.010; TB -1.36 ± 1.10 versus -0.48 ± 1.50, p = 0.018). Pain occurred in 11/30 (37%) with ON versus 20/56 (36%) without, p = 0.841. In multivariable models, older age at diagnosis (odds ratio [OR] 1.57; 95% confidence interval [CI], 1.15-2.13; p = 0.004), and hip BMD Z-score at MRI (OR 2.23; 95% CI, 1.02-4.87; p = 0.046) were independently associated with ON. Overall, one-third of children demonstrated ON after leukemia therapy. Those with ON had greater reductions in spine and hip BMD Z-scores in the first 1 and 2 years of therapy, respectively. Older age and lower hip BMD Z-scores at MRI were significantly associated with prevalent, off-therapy ON. These data assist in identifying children at risk of ON. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
| | - Jinui Ma
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paul Babyn
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mary Ann Matzinger
- Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Maya Scharke
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Conrad V Fernandez
- Department of Pediatric Hematology and Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paivi Miettunen
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Alos
- Département de Pédiatrie, Université de Montréal, Montréal, Quebec, Canada
| | - Sharon Abish
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Cairney
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - David B Dix
- Department of Pediatrics, University of British Columbia, Vancouver, British of Columbia, Canada
| | - Ronald M Grant
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Sara Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Victor Lewis
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Beverly Wilson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie Atkinson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - David Cabral
- Department of Pediatrics, University of British Columbia, Vancouver, British of Columbia, Canada
| | - Elizabeth Cummings
- Department of Pediatric Hematology and Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Celia Rodd
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Stein
- Department of Paediatrics, Western University, London, Ontario, Canada
| | | | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Khaldoun Koujok
- Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazih Shenouda
- Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada
| | - Frank Rauch
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Kerry Siminoski
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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Kuhlen M, Kunstreich M, Gökbuget N, Escherich G. [Osteonecrosis-severe side effect of treatment for acute lymphoblastic leukemia]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:792-799. [PMID: 36069910 DOI: 10.1007/s00132-022-04301-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Osteonecrosis occurs as an acute and long-term serious side effect in children, adolescents, and adults with acute lymphoblastic leukemia. It is associated with severe pain and reduced mobility, ultimately leading to joint destruction and significant long-term morbidity. The cumulative incidence ranges from 11 to 20% in adolescents and young adults. In symptomatic patients, multiple joints are frequently affected, which in turns poses a risk factor for the development of severe osteonecrosis. The genesis of leukemia-associated osteonecrosis is multifactorial. Risk factors include the use of corticosteroids and asparaginase. These exert their effects on the blood supply to the bone through hypercholesterolemia, hypertriglyceridemia, and hypertension. Bacteriemia, genetic susceptibility, and stem cell transplantation pose additional risk factors. The treatment of osteonecrosis is challenging and not evidence based. Preventive measurements have as yet mainly been tested in preclinical models.
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Affiliation(s)
- Michaela Kuhlen
- Schwäbisches Kinderkrebszentrum, Kinder- und Jugendmedizin, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - Marina Kunstreich
- Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Universitätskinderklinik, Magdeburg, Deutschland
| | - Nicola Gökbuget
- Medizinische Klinik II, Hämatologie/Onkologie, Universitätsklinikum Frankfurt/Main, Frankfurt/Main, Deutschland
| | - Gabriele Escherich
- Klinik für Pädiatrische Hämatologie und Onkologie, Universitätskinderklinik Hamburg-Eppendorf, Hamburg, Deutschland
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Valtis YK, Place AE, Silverman LB, Vrooman LM, DeAngelo DJ, Luskin MR. Orthopaedic adverse events among adolescents and adults treated with asparaginase for acute lymphoblastic leukaemia. Br J Haematol 2022; 198:421-430. [PMID: 35312041 DOI: 10.1111/bjh.18093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 01/19/2023]
Abstract
Osteonecrosis (ON) is a complication of acute lymphoblastic leukaemia (ALL) treatment with patient- (age, female sex, genetic polymorphisms, presence of metabolic syndrome) and treatment-specific (glucocorticoid type and schedule) risk factors described. The potential role of asparaginase in increasing risk of ON via effects on coagulation, lipid metabolism, and steroid clearance is now also recognised. Paediatric studies consistently identify age as a key risk factor for ON, with adolescents at higher risk than young children. Fewer studies comprehensively report on risk of ON in adults, but available evidence suggests that adolescents and young adults (AYAs) treated with corticosteroid and asparaginase-containing paediatric-inspired regimens are more at risk than older adults treated with paediatric-inspired or traditional adult regimens. There are few proven strategies to prevent or mitigate the severity of ON and other orthopaedic complications of ALL therapy. Future clinical trials should carefully ascertain orthopaedic adverse events in adults. Evidence-based guidelines should be developed for management of orthopaedic adverse events in adults being treated for ALL, especially high-risk AYAs being treated with paediatric-inspired regimens.
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Affiliation(s)
- Yannis K Valtis
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew E Place
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Division of Pediatric Hematology Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Division of Pediatric Hematology Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lynda M Vrooman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Division of Pediatric Hematology Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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6
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Periasamy U, Chilutti M, Kaplan SL, Hickey CP, Hayes K, Pennington JW, Balamuth F, Fitzgerald JC, Weiss SL. Prevalence of and Associations With Avascular Necrosis After Pediatric Sepsis: A Single-Center Retrospective Study. Pediatr Crit Care Med 2022; 23:e153-e161. [PMID: 34991135 PMCID: PMC8897239 DOI: 10.1097/pcc.0000000000002880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Avascular necrosis (AVN) is a rare, but serious, complication after sepsis in adults. We sought to determine if sepsis is associated with postillness diagnosis of AVN, as well as potential-associated risk factors for AVN in children with sepsis. DESIGN Retrospective observational study. SETTING Single academic children's hospital. PATIENTS Patients less than 18 years treated for sepsis or suspected bacterial infection from 2011 to 2017. Patients who developed AVN within 3 years after sepsis were compared with patients who developed AVN after suspected bacterial infection and with patients with sepsis who did not develop AVN. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS AVN was determined using International Classification of Diseases, 9th Edition/10th Edition codes and confirmed by chart review. The prevalence of AVN after sepsis was 0.73% (21/2,883) and after suspected bacterial infection was 0.43% (53/12,276; risk difference, 0.30; 95% CI, 0.0-0.63; p = 0.05). Compared with 43 sepsis controls without AVN, AVN in the 21 sepsis cases was associated with being older, having sickle cell disease and malignancy, higher body mass index, unknown source of infection, and low platelet count in the first 7 days of sepsis. Half of sepsis patients were treated with corticosteroids, and higher median cumulative dose of steroids was associated with AVN (23.2 vs 5.4 mg/kg; p < 0.01). Older age at infection (odds ratio [OR], 1.3; 95% CI, 1.1-1.4), malignancy (OR, 8.8; 95% CI, 2.6-32.9), unknown site of infection (OR, 12.7; 95% CI, 3.3-48.6), and minimal platelet count less than 100,000/µL in first 7 days of sepsis (OR, 5.0; 95% CI, 1.6-15.4) were identified as potential risk factors for AVN after sepsis following adjustment for multiple comparisons. CONCLUSIONS Although rare, sepsis was associated with a higher risk of subsequent AVN than suspected bacterial infection in children. Older age, malignancy, unknown site of infection, and minimum platelet count were potential risk factors for AVN after sepsis.
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Affiliation(s)
- Uvaraj Periasamy
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston MA, USA
| | - Marianne Chilutti
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Summer L. Kaplan
- Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Christopher P. Hickey
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
| | - Katie Hayes
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
| | - Jeffrey W. Pennington
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Fran Balamuth
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
- Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Julie C. Fitzgerald
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
- Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Scott L. Weiss
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
- Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
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Pulse therapy with vincristine and dexamethasone for childhood acute lymphoblastic leukaemia (CCCG-ALL-2015): an open-label, multicentre, randomised, phase 3, non-inferiority trial. Lancet Oncol 2021; 22:1322-1332. [PMID: 34329606 DOI: 10.1016/s1470-2045(21)00328-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vincristine plus dexamethasone pulses are generally used throughout maintenance treatment for childhood acute lymphoblastic leukaemia. However, previous studies remain inconclusive about the benefit of this maintenance therapy and the absence of randomised, controlled trials in patients with low-risk or high-risk acute lymphoblastic leukaemia provides uncertainty. We therefore aimed to determine if this therapy could be safely omitted beyond 1 year of treatment without leading to an inferior outcome in any risk subgroup of childhood acute lymphoblastic leukaemia. METHODS This open-label, multicentre, randomised, phase 3, non-inferiority trial involved 20 major medical centres across China. We enrolled patients who were aged 0-18 years with newly diagnosed acute lymphoblastic leukaemia that was subsequently in continuous remission for 1 year after initial treatment. Patients with secondary malignancy or primary immunodeficiency were excluded. Eligible patients were classified as having low-risk, intermediate-risk, or high-risk acute lymphoblastic leukaemia based on minimal residual disease and immunophenotypic and genetic features of leukaemic cells. Randomisation and analyses were done separately for the low-risk and intermediate-to-high-risk cohorts. Randomisation was generated by the study biostatistician with a block size of six. Stratification factors included participating centre, sex, and age at diagnosis; the low-risk cohort was additionally stratified for ETV6-RUNX1 status, and the intermediate-to-high-risk cohort for cell lineage. Patients in each risk cohort were randomly assigned (1:1) to either receive (ie, the control group) or not receive (ie, the experimental group) seven pulses of intravenous vincristine (1·5 mg/m2) plus oral dexamethasone (6 mg/m2 per day for 7 days) during the second year of treatment. The primary endpoint was difference in 5-year event-free survival between the experimental group and the control group for both the low-risk and intermediate-to-high-risk cohorts, with a non-inferiority margin of 0·05 (5%). The analysis was by intention to treat. This trial is registered with the Chinese Clinical Trial Registry, ChiCTR-IPR-14005706. FINDINGS Between Jan 1, 2015, and Feb 20, 2020, 6141 paediatric patients with newly diagnosed acute lymphoblastic leukaemia were registered to this study. Approximately 1 year after diagnosis and treatment, 5054 patients in continuous remission were randomly assigned, including 2923 (1442 in the control group and 1481 in the experimental group) with low-risk acute lymphoblastic leukaemia and 2131 (1071 control, 1060 experimental) with intermediate-to-high risk acute lymphoblastic leukaemia. Median follow-up for patients who were alive at the time of analysis was 3·7 years (IQR 2·8-4·7). Among patients with low-risk acute lymphoblastic leukaemia, no difference was observed in 5-year event-free survival between the control group and the experimental group (90·3% [95% CI 88·4-92·2] vs 90·2% [88·2-92·2]; p=0·90). The one-sided 95% upper confidence bound for the difference in 5-year event-free survival probability was 0·024, establishing non-inferiority. Among patients with intermediate-to-high-risk acute lymphoblastic leukaemia, no difference was observed in 5-year event-free survival between the control group and the experimental group (82·8% [95% CI 80·0-85·7] vs 80·8% [77·7-84·0]; p=0·90), but the one-sided 95% upper confidence bound for the difference in 5-year event-free survival probability was 0·055, giving a borderline inferior result for those in the experimental group. In the low-risk cohort, we found no differences in the rates of infections, symptomatic osteonecrosis, or other complications during the second year of maintenance treatment between patients in the control and experimental groups. Patients with intermediate-to-high-risk acute lymphoblastic leukaemia in the control group were more likely to develop grade 3-4 pneumonia (26 [2·4%] of 1071 vs ten [0·9%] of 1060) and vincristine-related peripheral neuropathy (17 [1·6%] vs six [0·6%]) compared with the experimental group. Incidence of grade 5 fatal infection was similar between the control group and the experimental group in both the low-risk cohort (two [0·1%] of 1442 vs five [0·3%] of 1481) and intermediate-to-high risk cohort (six [0·6%] of 1071 vs five [0·5%] of 1060). INTERPRETATION Vincristine plus dexamethasone pulses might be omitted beyond 1 year of treatment for children with low-risk acute lymphoblastic leukaemia. Additional studies are needed for intermediate-to-high-risk acute lymphoblastic leukaemia. FUNDING VIVA China Children's Cancer Foundation, the National Natural Science Foundation of China, the China fourth round of Three-Year Public Health Action Plan (2015-2017), Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, US National Cancer Institute, St Baldrick's Foundation, and the American Lebanese Syrian Associated Charities. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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8
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Maintenance therapy and risk of osteonecrosis in children and young adults with acute lymphoblastic leukemia: a NOPHO ALL2008 sub-study. Cancer Chemother Pharmacol 2021; 88:911-917. [PMID: 34145469 DOI: 10.1007/s00280-021-04316-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/07/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Osteonecrosis is a burdensome treatment-related toxicity that is mostly diagnosed during or soon after 6-mercaptopurine (6MP)/methotrexate (MTX) maintenance therapy for acute lymphoblastic leukemia (ALL), possibly indicating a pathogenic role of these drugs. METHODS We prospectively registered symptomatic osteonecrosis during treatment of 1234 patients aged 1.0-45.9 years treated according to the Nordic Society of Hematology and Oncology (NOPHO) ALL2008 protocol. MTX/6MP metabolites were measured as part of the NOPHO ALL2008 maintenance therapy study. RESULTS After a median follow-up of 5.6 years [interquartile range (IQR) 3.6-7.5], 68 patients had been diagnosed with symptomatic osteonecrosis. The cumulative incidence was 2.7% [95% confidence interval (CI) 1.6-3.8%] for patients aged < 10 years, 14.9% (95% CI 9.7-20.2%) for patients aged 10.0-17.9 years, and 14.4% (95% CI 8.0-20.8%) for patients aged ≥ 18 years. The median time from diagnosis of ALL to diagnosis of osteonecrosis in these age groups was 1.0 year (IQR 0.7-2.0), 2.0 years (IQR 1.1-2.4), and 2.2 years (IQR 1.8-2.8), respectively (p = 0.001). With 17,854 blood samples available for MTX and 6MP metabolite analysis, neither erythrocyte levels of 6-thioguanine (TG) nucleotides (p > 0.99), methylated 6MP metabolites (p = 0.37), MTX polyglutamates (p = 0.98) nor DNA-TG (p = 0.53) were significantly associated with the hazard of osteonecrosis in Cox models stratified by the three age groups and adjusted for sex. CONCLUSION Maintenance therapy intensity determined by 6MP and MTX metabolites was not associated with the risk of developing osteonecrosis in the NOPHO ALL2008 cohort.
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Arakawa Y, Masutani S, Oshima K, Mitani Y, Mori M, Fukuoka K, Moriwaki K, Kato M, Taira K, Tanami Y, Nakazawa A, Koh K. Asian population may have a lower incidence of hip osteonecrosis in childhood acute lymphoblastic leukemia. Int J Hematol 2021; 114:271-279. [PMID: 34008044 DOI: 10.1007/s12185-021-03163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
Osteonecrosis (ON), a long-term complication of acute lymphoblastic leukemia (ALL) treatment affects patients' quality of life. Although the incidence of any ON, including asymptomatic, was 21.7% among children with ALL in the U.S., the actual incidence and risk factors in Asia remain unknown. For over 11 years, we performed hip magnetic resonance imaging (MRI) screening to detect asymptomatic ON while initiating maintenance chemotherapy in newly diagnosed children with ALL. Overall, 164 of 175 patients underwent hip MRI screening. The incidence of symptomatic or any ON was 3.0% and 11.6%, respectively. Asymptomatic ON in patients < 10 and ≥ 10 years old was 4.0% and 35.9%, respectively (P < 0.001). In multivariate analysis, age ≥ 10 years was the only significant risk factor. Asymptomatic ON with necrosis of > 30% of the epiphyseal surface of the femoral head was detected in four patients (2.4%). All were ≥ 10 years. Three of them progressed to severe symptomatic ON. The incidence of any ON in Asia may be lower than that seen in the only screening study in the U.S. Future studies should clarify factors affecting such regional differences and develop an effective approach to avoid the progression of ON in children with ALL.
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Affiliation(s)
- Yuki Arakawa
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan. .,Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Koichi Oshima
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan
| | - Yuichi Mitani
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan
| | - Makiko Mori
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan
| | - Kohei Fukuoka
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan
| | - Koichi Moriwaki
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Motohiro Kato
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Katsuaki Taira
- Department of Orthopedics Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Atsuko Nakazawa
- Department of Pathology, Saitama Children's Medical Center, Saitama, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan
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10
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Zhu D, Yu H, Liu P, Yang Q, Chen Y, Luo P, Zhang C, Gao Y. Calycosin modulates inflammation via suppressing TLR4/NF-κB pathway and promotes bone formation to ameliorate glucocorticoid-induced osteonecrosis of the femoral head in rat. Phytother Res 2021; 35:2824-2835. [PMID: 33484002 DOI: 10.1002/ptr.7028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022]
Abstract
Glucocorticoid (GC) administration is one of the main causes of osteonecrosis of the femoral head (ONFH). Inflammation, especially the TLR4/NF-κB pathway, has been demonstrated to play a pivotal role in the pathogenesis of GC-induced ONFH. Calycosin, the main bioactive extract of Astragali Radix, could substantially regulate the TLR4/NF-κB pathway. Therefore, in this study, we hypothesized that calycosin could exert beneficial effects in GC-induced ONFH. In vitro, effects of calycosin on the osteogenic differentiation of human bone mesenchymal stem cells (hBMSCs) were determined using Alizarin red staining, alkaline phosphatase activity examination, and osteogenic-related gene assay. Meanwhile, inflammatory cytokines were detected by enzyme-linked immunosorbent assay. In vivo, 60 male Sprague-Dawley rats were randomly separated into three groups: the control group, the methylprednisolone (MPS) group, and the MPS + calycosin group. The results showed that calycosin could significantly promote dynamic bone formation and retard TLR4/NF-κB pathway. in vivo investigations indicated that calycosin could decrease the morbidity of ONFH and alleviate pathological manifestations within the femoral head. Meanwhile, calycosin could protect osseous blood supply and facilitate dynamic bone formation. The findings collectively demonstrated that calycosin could ameliorate GC-induced ONFH in rat and might become a potential candidate for pharmaceutical prevention of this intractable disease.
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Affiliation(s)
- Daoyu Zhu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongping Yu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Pei Liu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qianhao Yang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yixuan Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Pengbo Luo
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Changqing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Youshui Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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11
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Total Hip Arthroplasty in Adolescents and Young Adults for Management of Advanced Corticosteroid-Induced Osteonecrosis Secondary to Treatment for Hematologic Malignancies. J Arthroplasty 2021; 36:1352-1360. [PMID: 33281023 DOI: 10.1016/j.arth.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a potentially severe toxicity associated with glucocorticoid treatment for pediatric hematologic malignancy. We examined clinical outcomes of THA in adolescents and young adults treated for hematologic malignancies who developed advanced ONFH. METHODS In a single-institution cohort, we retrospectively reviewed medical records and imaging for perioperative complications, reoperations, functional assessment at last follow-up, and radiological outcomes. Twenty-seven patients (41 hips) underwent THA (bilateral in 14 patients). There were 11 males. Median (interquartile range [IQR]) age at primary diagnosis was 14.9 years [1.8-18.9]. The median (IQR) age at THA was 19.8 years [14.6-30.3]. Mean (range) post-THA follow-up was 111.5 months (65.4-165.8). RESULTS Perioperative complications included one intraoperative calcar fracture that was secured with a cerclage wire and one posterior hip dislocation that occurred 6 days postoperatively, requiring closed reduction. One hip required a revision 21.1 months post-THA due to a fractured ceramic liner. The radiographic review was available for 38 of 41 hips and demonstrated none with loosening, subsidence, or osteolysis; nine developed periacetabular stress shielding. Incidence of stress shielding was associated with increased postoperative pain (P = .0130). There was a significant functional improvement in range of motion (ROM), pain, use of supports, participation in school, work, and sports, and use of pain medication from preoperative to postoperative clinical visits (P < .001). DISCUSSION Total hip arthroplasty in adolescents and young adults offers symptomatic and functional improvement in patients with ONFH. We found it to be safe with low perioperative complication rates even in patients undergoing active treatment for malignancy. LEVEL OF EVIDENCE Level IV, case series study. See Instructions for authors for a complete description of levels of evidence.
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12
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Moderate-severe grade of chronic graft versus host disease and younger age (less than 45 years old) are risk factors for avascular necrosis in adult patients undergoing allogeneic hematopoietic cell transplantation. Ann Hematol 2021; 100:1311-1319. [PMID: 33710366 DOI: 10.1007/s00277-021-04480-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Avascular necrosis (AVN) is a debilitating complication of allogeneic hematopoietic cell transplantation (HCT). A retrospective review of 845 patients who underwent HCT was conducted. Cumulative incidence of AVN was 6.3% at 4 years. The following risk factors were significantly associated with AVN risk on univariate analysis: age < 45 (p=0.004), moderate to severe chronic GvHD (p<0.001), reduced intensity conditioning (p=0.02), and a diagnosis of acute leukemia (p=0.045). Multivariate analysis confirmed two risk factors: younger age (<45 years), 9.0% vs 4.4% (p=0.011, hazard ratio (HR) 2.134), and moderate-severe chronic GvHD, 15.4% vs 2.1% (p<0.001, HR 4.950). A risk score model was generated assigning a score to each risk factor. A score of 1 was assigned to moderate-severe GvHD or those with age <45. Total score was calculated, thus dividing patient into three groups: low (score 0, n=349, 41.3%), intermediate (score 1, n=379, 44.9%), and high risk (score 2; n=116, 13.7%). This risk score could stratify the patients according to AVN risk (p<0.001). The risk of AVN was 1.5% in the low risk, 6.2% in the intermediate risk, and 20.8% in the high risk groups. Moderate-severe chronic GvHD and younger age (<45 years) are key risk factors for AVN following allogeneic HCT.
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13
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Devilli L, Garonzi C, Balter R, Bonetti E, Chinello M, Zaccaron A, Vitale V, De Bortoli M, Caddeo G, Baretta V, Tridello G, Cesaro S. Long-term and quality of survival in patients treated for acute lymphoblastic leukemia during the pediatric age. Hematol Rep 2021; 13:8847. [PMID: 33747412 PMCID: PMC7967269 DOI: 10.4081/hr.2021.8847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Long-term survival for acute lymphoblastic leukemia (ALL) in children improved over the last three decades up to 80-90% of affected patients. Consequently, the quality of life of survivors has become increasingly important. This study analyses the clinical features and outcome of 119 children with ALL, focusing on the quality of long-term survival in a subset of 22 patients over 18 years of age. Among this group, the 10-year event-free survival and overall survival were 83.1% (C.I. 74.0-89.2) and 88.4% (C.I. 80.9-93.1), respectively. Treatment related long-term medical complications were reported only in 2 patients (9.1%). Secondary school was completed successfully in 20 of 22 patients (89.9%). The remaining 2 patients were still attending at the time of the analysis. In conclusion, current treatment for ALL is well tolerated and does not compromise significantly the quality of life of survivors.
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Affiliation(s)
- Lara Devilli
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Chiara Garonzi
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rita Balter
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elisa Bonetti
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Chinello
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ada Zaccaron
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Virginia Vitale
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Massimilano De Bortoli
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giulia Caddeo
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Valentina Baretta
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gloria Tridello
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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14
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Gupta A, Damania RC, Talati R, O'Riordan MA, Matloub YH, Ahuja SP. Increased Toxicity Among Adolescents and Young Adults Compared with Children Hospitalized with Acute Lymphoblastic Leukemia at Children's Hospitals in the United States. J Adolesc Young Adult Oncol 2021; 10:645-653. [PMID: 33512257 DOI: 10.1089/jayao.2020.0154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose: Adolescent and young adult (AYA) patients (15-39 years old) with acute lymphoblastic leukemia (ALL) have less favorable outcomes and higher treatment-related mortality as compared with older children with ALL. Minimal data exist regarding how well AYA patients tolerate the intensity of chemotherapy at doses and regimens designed for children, and the toxicities suffered by this population at children's hospitals have not been thoroughly characterized. Methods: Pediatric Health Information Systems database was queried to analyze health care outcomes in pediatric (ages 10-14) and AYA patients (ages 15-39) with ALL hospitalized between January 1999 and December 2014. We extracted relevant ICD-9 data for each patient related to grades 3 or 4 toxicities as outlined by the NCI. Results: A total of 5345 hospital admissions met inclusion criteria, representing 4046 unique patients. Of these admissions, 2195 (41.1%) were in the AYA age group, and the remainder were in the 10-14-year-old group. AYA patients had a significantly higher incidence of intensive care unit stay but no difference in median hospital stay nor mortality. AYA patients had increased toxicities in almost every organ system as compared with older children. Conclusions: In this large multicenter US database study, we found an overall increased number of toxicities among AYA patients with ALL in children's hospitals. Compared with children between the ages of 10 and 15, AYA patients developed disproportionately higher toxicities from drugs commonly used in pediatric protocols for ALL. Prospective studies are needed to assess whether dose modifications for certain chemotherapeutics may improve the toxicity profile and health care burden of AYA patients with ALL treated in children's hospitals.
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Affiliation(s)
- Ajay Gupta
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Rahul C Damania
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ravi Talati
- Division of Hematology, Oncology, and Blood and Marrow Transplant, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Mary Ann O'Riordan
- Women's & Children's Services, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Yousif H Matloub
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sanjay P Ahuja
- Division of Pediatric Hematology/Oncology, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
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15
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Jones LC, Kaste SC, Karol SE, DeFeo B, Kim HKW, Neel MD, Levin AS. Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28509. [PMID: 32860663 DOI: 10.1002/pbc.28509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
With current treatments for acute lymphoblastic leukemia (ALL), the overall prognosis for survival is favorable. Increasing emphasis is placed on recognizing and managing the long-term consequences of ALL and its treatment, particularly involving osteonecrosis. Early osteonecrosis diagnosis and management may improve outcomes and is best accomplished through coordinated teams that may include hematologic oncologists, radiologists, orthopedic surgeons, physical therapists, and the patient and their family. Magnetic resonance imaging is the "gold standard" for diagnosis of early-stage and/or multifocal osteonecrosis. Treatments for osteonecrosis in ALL patients are risk stratified and may include observation, corticosteroid or chemotherapy adjustment, and pharmaceutical or surgical approaches.
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Affiliation(s)
- Lynne C Jones
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Seth E Karol
- Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brian DeFeo
- Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Harry K W Kim
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, UT Southwestern Medical Center, Dallas, Texas
| | - Michael D Neel
- Division of Orthopaedics, St. Jude Children's Research Hospital, Memphis, TN
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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16
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Inaba H, Varechtchouk O, Neel MD, Ehrhardt MJ, Metzger ML, Karol SE, Ness KK, Ribeiro RC, Pui CH, Relling MV, Sandlund JT, Kaste SC. Whole-joint magnetic resonance imaging to assess osteonecrosis in pediatric patients with acute lymphoblastic lymphoma. Pediatr Blood Cancer 2020; 67:e28336. [PMID: 32472969 PMCID: PMC7391358 DOI: 10.1002/pbc.28336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/04/2020] [Accepted: 03/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Osteonecrosis is a debilitating complication in children and adolescents with acute lymphoblastic leukemia or acute lymphoblastic lymphoma (LLy). An objective screening test to identify patients at risk for symptomatic, extensive joint involvement will help manage osteonecrosis. METHODS We performed a prospective, longitudinal pilot study with whole-joint magnetic resonance imaging (MRI) of shoulders, elbows, hips, knees, ankles, and hindfeet to evaluate the incidence and timing of osteonecrosis involving multiple joints in 15 patients with LLy aged 9-21 years at diagnosis. RESULTS Osteonecrosis affecting ≥30% of the epiphysis occurred in eight of 15 patients, with a high prevalence in hips (12 of 26 examined [46%]) and knees (10 of 26 [38%]) post reinduction I and in shoulders (seven of 20 [35%]) post reinduction II. Most osteonecrotic hips and knees with ≥30% epiphyseal involvement became symptomatic and/or underwent surgery (100% and 82%, respectively). All eight patients with ≥30% epiphyseal involvement had multijoint involvement. Seven of these patients had hip or knee osteonecrosis by the end of remission induction, and only these patients developed osteonecrosis that became symptomatic and/or underwent surgery in their hips, knees, shoulders, ankles, and/or feet; all of these joints were associated with epiphyseal abnormalities on post reinduction I imaging. CONCLUSIONS MRI screening in adolescent patients with LLy revealed osteonecrosis in multiple joints. Initial screening with hip and knee MRI at the end of induction may identify susceptible patients who could benefit from referrals to subspecialties, more extensive follow-up imaging of other joints, and early medical and surgical interventions.
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Affiliation(s)
- Hiroto Inaba
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Olga Varechtchouk
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Michael D. Neel
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew J. Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Monika L. Metzger
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee,Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Seth E. Karol
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mary V. Relling
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John T. Sandlund
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sue C. Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee;,Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
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17
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Karol SE, Pui CH. Personalized therapy in pediatric high-risk B-cell acute lymphoblastic leukemia. Ther Adv Hematol 2020; 11:2040620720927575. [PMID: 32537116 PMCID: PMC7268159 DOI: 10.1177/2040620720927575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Although cure rates for pediatric acute lymphoblastic leukemia (ALL) have now risen to more than 90%, subsets of patients with high-risk features continue to experience high rates of treatment failure and relapse. Recent work in minimal residual disease stratification and leukemia genomics have increased the ability to identify and classify these high-risk patients. In this review, we discuss this work to identify and classify patients with high-risk ALL. Novel therapeutics, which may have the potential to improve outcomes for these patients, are also discussed.
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Affiliation(s)
- Seth E Karol
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl., Mail Stop 260, Memphis, TN 38105, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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18
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Kaste S, Suliman AY, Li Y, Keerthi D, Kang G, Triplett B, Srinivasan A. Pre- and post-magnetic resonance imaging of hips and knees for detecting osteonecrosis in children and adolescents undergoing hematopoietic cell transplantation. Bone Marrow Transplant 2020; 55:1837-1839. [PMID: 32265502 DOI: 10.1038/s41409-020-0882-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Sue Kaste
- Department of Radiology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ali Y Suliman
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ying Li
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Dinesh Keerthi
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Brandon Triplett
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ashok Srinivasan
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA. .,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
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19
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Inaba H, Cao X, Chang JY, Karol SE, Panetta JC, Ness KK, Cheng C, Pui CH, Relling MV, Kaste SC. Incidence of hip and knee osteonecrosis and their associations with bone mineral density in children with acute lymphoblastic leukaemia. Br J Haematol 2020; 189:e177-e181. [PMID: 32207157 DOI: 10.1111/bjh.16589] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Xueyuan Cao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Acute and Tertiary Care, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer Y Chang
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,University of Illinois College of Medicine, Chicago, IL, USA
| | - Seth E Karol
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - John C Panetta
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sue C Kaste
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA
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Agarwala S, Banavali SD, Vijayvargiya M. Bisphosphonate Combination Therapy in the Management of Postchemotherapy Avascular Necrosis of the Femoral Head in Adolescents and Young Adults: A Retrospective Study From India. J Glob Oncol 2019; 4:1-11. [PMID: 30241233 PMCID: PMC6223416 DOI: 10.1200/jgo.17.00083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose With improved survival after chemotherapy for acute lymphoblastic leukemia (ALL), it is imperative to maintain good quality of life as part of the management of post-therapy adverse effects. Avascular necrosis of the femoral head (AVNFH) is one such adverse effect. A need exists for a therapy that ameliorates discomfort, provides a productive life, is cost effective, and is joint preservative. We conducted the current study to evaluate the response to bisphosphonate in the nonsurgical management of AVNFH in adolescents and young adults (AYA) who receive treatment for ALL. Materials and Methods This is a retrospective study of 20 AYA patients—34 affected hips—who received zolendronic acid 5 mg intravenously each year along with oral alendronate 70 mg weekly for 3 years. Clinical evaluation was performed by using the Visual Analog Scale and the Harris Hip Score. Radiographs were used to classify the Ficat-Arlet stage, monitor radiologic collapse, and evaluate the rate of progression. Results Pain relief with a drop in the Visual Analog Scale score was observed at a mean duration of 5.2 weeks (range, 3 weeks to 11 weeks) after the start of therapy. Radiologic progression by one grade was observed in 12 hips (35.3%), and only one hip (2.94%) showed progression by two grades. At a mean follow-up of 50.3 months, 31 affected hips (91.1%) had a satisfactory clinical outcome and had not required any surgical intervention. The proportion of hips that required total hip arthroplasty were 0%, 5%, and 22.2% in Ficat-Arlet stage I, II, and III, respectively. Conclusion The combination of intravenous zolendronic acid and oral alendronate provides a pragmatic solution for the management of AVNFH after therapy for ALL in AYA patients. This therapy is safe, effective, and well tolerated.
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Affiliation(s)
- Sanjay Agarwala
- Sanjay Agarwala and Mayank Vijayvargiya, P.D. Hinduja Hospital and Medical Research Centre; and Shripad D. Banavali, Tata Memorial Centre, Mumbai, India
| | - Shripad D Banavali
- Sanjay Agarwala and Mayank Vijayvargiya, P.D. Hinduja Hospital and Medical Research Centre; and Shripad D. Banavali, Tata Memorial Centre, Mumbai, India
| | - Mayank Vijayvargiya
- Sanjay Agarwala and Mayank Vijayvargiya, P.D. Hinduja Hospital and Medical Research Centre; and Shripad D. Banavali, Tata Memorial Centre, Mumbai, India
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21
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Hypertension is a modifiable risk factor for osteonecrosis in acute lymphoblastic leukemia. Blood 2019; 134:983-986. [PMID: 31409674 DOI: 10.1182/blood.2019000006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Amin N, Kinsey S, Feltbower R, Kraft J, Whitehead E, Velangi M, James B. British OsteoNEcrosis Study (BONES) protocol: a prospective cohort study to examine the natural history of osteonecrosis in older children, teenagers and young adults with acute lymphoblastic leukaemia and lymphoblastic lymphoma. BMJ Open 2019; 9:e027204. [PMID: 31122988 PMCID: PMC6538027 DOI: 10.1136/bmjopen-2018-027204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Osteonecrosis is a well-recognised treatment-related morbidity risk in patients diagnosed with acute lymphoblastic leukaemia (ALL) and lymphoblastic lymphoma (LBL), with a high rate of affected patients requiring surgical intervention. Patients may have asymptomatic changes on imaging studies that spontaneously regress, and little is known about the natural history of osteonecrotic changes seen. The main aim of the British OsteoNEcrosis Study (BONES) is to determine the incidence of symptomatic and asymptomatic osteonecrosis in the lower extremities of survivors of ALL or LBL diagnosed aged 10-24 years in the UK at different time points in their treatment. This study also aims to identify risk factors for progression and the development of symptomatic osteonecrosis in this population, as well as specific radiological features that predict for progression or regression in those with asymptomatic osteonecrosis METHODS AND ANALYSIS: BONES is a prospective, longitudinal cohort study based at principal treatment centres around the UK. Participants are patients aged 10-24 years diagnosed with ALL or LBL under standard criteria. Assessment for osteonecrosis will be within 4 weeks of diagnosis, at the end of delayed intensification and 1, 2 and 3 years after the start of maintenance therapy. Assessment will consist of MRI scans of the lower limbs and physiotherapy assessment. Clinical and biochemical data will be collected at each of the time points. Bone mineral density data and vertebral fracture assessment using dual-energy X-ray absorptiometry will be collected at diagnosis and annually for 3 years after diagnosis of malignancy. ETHICS AND DISSEMINATION Ethical approval has been obtained through the Yorkshire and Humber Sheffield Research Ethics Committee (reference number: 16/YH/0206). Study results will be published on the study website, in peer-reviewed journals and presented at relevant conferences and via social media. TRIAL REGISTRATION NUMBER NCT02598401; Pre-results.
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Affiliation(s)
- Nadia Amin
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sally Kinsey
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Paediatric Haematology, Leeds Children’s Hospital, Leeds, UK
| | | | - Jeannette Kraft
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | - Mark Velangi
- Department of Paediatric Haematology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Beki James
- Department of Paediatric Haematology, Leeds Children’s Hospital, Leeds, UK
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23
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Mulrooney DA, Hyun G, Ness KK, Bhakta N, Pui CH, Ehrhardt MJ, Krull KR, Crom DB, Chemaitilly W, Srivastava DK, Relling MV, Jeha S, Green DM, Yasui Y, Robison LL, Hudson MM. The changing burden of long-term health outcomes in survivors of childhood acute lymphoblastic leukaemia: a retrospective analysis of the St Jude Lifetime Cohort Study. LANCET HAEMATOLOGY 2019; 6:e306-e316. [PMID: 31078468 DOI: 10.1016/s2352-3026(19)30050-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/16/2019] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Treatment for childhood acute lymphoblastic leukemia has evolved over the past five decades, with moderation of traditional chemotherapy and radiotherapy and the introduction of targeted immune-based and cellular-based therapies. The affect of these changes on late health outcomes has not been assessed. Using data from the The St Jude Lifetime (SJLIFE) Cohort, we aimed to characterise the magnitude of morbidity and patterns of late health outcomes among survivors of childhood acute lymphoblastic leukaemia treated over time. METHODS The St Jude Lifetime (SJLIFE) Cohort is a retrospective cohort study with prospective follow-up and ongoing data accrual designed to facilitate longitudinal, clinically-based assessment of health outcomes among survivors of paediatric malignancies. 980 survivors included in this analysis were diagnosed with paediatric acute lymphoblastic leukaemia at St Jude Children's Research Hospital (SJCRH) between Aug 28, 1963, and July 19, 2003, were aged 18 years old and older at enrolment, had a minimum follow-up of 10 years after diagnosis, and completed an initial on-campus SJLIFE assessment as of data cutoff (June 30, 2015). 272 community control participants, matched to survivors on 5-year age blocks in each sex, were recruited for comparison. Cumulative chemotherapy and radiation dose exposures and major medical events during and after therapy were retrieved from the medical records of the survivors. History or physical examination, laboratory analysis, physical fitness, and neurocognitive testing were done. Health conditions were graded according to a modified version of the Common Terminology Criteria for Adverse Events. Neurocognitive domains of attention (Trial Making Test Part A and Conner's Continuous Performance Test-II) and executive function (Trail Making Test Part B, Controlled Oral Word Association Test, and Wechsler Adult Intelligence Scale-III Digit Span Test Backward) were measured and age-adjusted Z scores were calculated. Mean cumulative count was used to calculate the age-standardised cumulative burden of health conditions over time. This cohort study is registered at ClinicalTrials.gov, number NCT00760656. FINDINGS 980 survivors of acute lymphoblastic leukaemia (50% women, median age at diagnosis 5 years [IQR 3·1-9·1 years], and median time from diagnosis of 30·0 years [22·7-36·3]) had a median age of 35·8 years (29·4-42·9) at assessment compared with 35·1 years (28·7-42·6) for 272 controls. Survivors had significantly more growth hormone deficiency, hypogonadism, and neuropathy than controls. By age 30 years, survivors of acute lymphoblastic leukaemia had, on average, 5·4 (95% CI 5·1-5·8) grade 1-4 health conditions, including 3·2 (2·9-3·4) grade 2-4 health conditions, compared with 2·0 (CI 1·7-2·2) grade 1-4 and 1·2 (1·03-1·4) grade 2-4 health conditions among controls. The cumulative burden of grade 2-4 health conditions involved multiple organ systems for survivors treated on protocols between 1962-91, but after elimination of cranial radiotherapy for children with acute lymphoblastic leukaemia, conditions now predominately include musculoskeletal and endocrine disorders for survivors on protocols between 1991-2007. INTERPRETATION Although changes in paediatric acute lymphoblastic leukaemia treatment protocols have improved overall survival, the burden of late morbidity remains high for these patients. We show that the pattern of late toxic effects has markedly changed over time, with survivors having a reduction in health conditions that are immediately life-threatening, however, maintaining health status and quality of life for survivors of paediatric acute lymphoblastic leukaemia requires continued medical surveillance, counselling, and lifestyle modifications. FUNDING US National Cancer Institute and the American Lebanese Syrian Associated Charities.
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Affiliation(s)
- Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Departments of Pediatrics and Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA.
| | - Geehong Hyun
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Deborah B Crom
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Mary V Relling
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sima Jeha
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel M Green
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Departments of Pediatrics and Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
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Niinimäki R, Suo-Palosaari M, Pokka T, Harila-Saari A, Niinimäki T. The radiological and clinical follow-up of osteonecrosis in cancer patients. Acta Oncol 2019; 58:505-511. [PMID: 30698062 DOI: 10.1080/0284186x.2019.1566769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In patients with cancer, osteonecrosis (ON) lesions can affect multiple sites throughout the skeleton, including the long and short bones and the joints. The aims of this study were to explore the natural course of ON in patients treated for cancer by using radiological classification suitable for multisite ON lesions and to assess correlations between the ON grade and surgical procedures. MATERIAL AND METHODS Data were retrieved from hospital databases on 233 ON lesions in 54 patients (aged 2-73 years at cancer diagnosis; mean age: 25 years). ONs were graded according to the Niinimäki classification, based on magnetic resonance images. Medical records were reviewed to identify surgical procedures. RESULTS A total of 14 different ON sites were detected; the hip was the most common site (n = 51), followed by the femur (n = 45), tibia (n = 41) and knee (n = 37). Among the 233 ON lesions, 78.1% did not require surgical procedures. The remaining lesions required total joint arthroplasty (TJA; 40/233, 17.2%), core decompression (3.4%) and arthroscopy (1.3%). Most TJAs (33/40, 82.5%) were performed on the hip. ONs of the knee required TJAs only once; grade 3 knee ONs frequently healed (58%, 11/19). None of the diaphyseal or metaphyseal (grade 1-2) ONs of the long bones required surgery, and no fractures of those bones were identified. CONCLUSIONS In conclusion, the natural history of ONs varied by the grade and site. Based on our findings, we would not recommend routine radiological follow-ups for grades 1-2 ON lesions that do not affect the joints, because the clinical consequences of those lesions appear to be minimal, although pain relief would be warranted. In contrast, joint deformations (grade 5) require surgery; therefore, intervention studies should focus on grades 3-4 ON lesions.
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Affiliation(s)
- Riitta Niinimäki
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Maria Suo-Palosaari
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Tytti Pokka
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Arja Harila-Saari
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Gottumukkala RV, Gee MS, Hampilos PJ, Greer MLC. Current and Emerging Roles of Whole-Body MRI in Evaluation of Pediatric Cancer Patients. Radiographics 2019; 39:516-534. [DOI: 10.1148/rg.2019180130] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ravi V. Gottumukkala
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
| | - Michael S. Gee
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
| | - Perry J. Hampilos
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
| | - Mary-Louise C. Greer
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
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Osteonecrosis in pediatric cancer survivors: Epidemiology, risk factors, and treatment. Surg Oncol 2019; 28:214-221. [PMID: 30851903 DOI: 10.1016/j.suronc.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/25/2019] [Accepted: 02/02/2019] [Indexed: 01/30/2023]
Abstract
Several treatment regimens for childhood malignancies have been associated with the development of osteonecrosis, including radiation therapy, glucocorticoid medications, immunotherapy (including anti-angiogenic agents), and several chemotherapeutic agents. Adolescents older than 10 years are at greatest risk of developing osteonecrosis within 1 year of initiating therapy. Screening with magnetic resonance imaging in this high-risk population may be a useful method for detecting osteonecrosis. Surgery may be required for lesions that have progressed substantially despite nonoperative interventions.
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Osteonecrosis of the Shoulders in Pediatric Patients Treated for Leukemia or Lymphoma: Single-Institutional Experience. J Pediatr Orthop 2019; 39:104-110. [PMID: 28452860 PMCID: PMC5659977 DOI: 10.1097/bpo.0000000000000900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteonecrosis of the hips and knees is an often debilitating adverse event in children treated with glucocorticoids for leukemia and lymphoma but the impact of shoulder involvement has been understudied. Thus, we investigated the severity and functional impairment of shoulder osteonecrosis in a well-characterized population of pediatric patients treated for acute lymphoblastic leukemia or lymphoma. METHODS We retrospectively reviewed orthopaedic clinic and physical therapy evaluations to determine range of motion (ROM), pain, and impact of magnetic resonance-defined osteonecrosis (ON) on activities of daily living. Adverse events were classified according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.03. RESULTS We identified 35 patients (22 female), median age at cancer diagnosis 14.2 (range, 4.3 to 19) years; median age at ON diagnosis 16.7 (range, 5.5 to 28) years. Median time to last follow-up from diagnosis of primary malignancy was 6.4 (range, 0 to 12.7) years and from diagnosis of ON was 4.0 (range, 0 to 8.9) years. Twenty-two patients had magnetic resonance evidence of ON; 43 shoulders involved at least 30% of the articular surface of the capital humeral epiphyses.Common Terminology Criteria for Adverse Events mean scores for initial assessments of 55 shoulders (29 patients) showed moderate negative impact of ON on activity of daily living (1.94), decreased ROM limiting athletic activity (0.98), and mild to moderate levels of pain (1.38). Analysis of this group's most recent assessment showed improvement in pain and ON over time, with an average pain grade of 0.58 indicating no pain to mild pain, and 1.37 for ON grade, indicating asymptomatic to mildly symptomatic impact on activities of daily living. We also found minimal worsening average ROM grades (1.11). CONCLUSIONS Shoulder ON is an underappreciated adverse late effect of therapy in children treated for leukemia/lymphoma which can limit quality of life and functionality. In most cases, pain and disability can be improved with treatment. LEVEL OF EVIDENCE Level IV-case series.
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28
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Ali N, Gohar S, Zaky I, Elghoneimy A, Youssef S, Sameer G, Yassin D, Salem S, Magdi H, Sidhom I. Osteonecrosis in children with acute lymphoblastic leukemia: A report from Children's Cancer Hospital Egypt (CCHE). Pediatr Blood Cancer 2019; 66:e27440. [PMID: 30183135 DOI: 10.1002/pbc.27440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 07/14/2018] [Accepted: 08/01/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND As survival rates for children with acute lymphoblastic leukemia (ALL) improve, awareness of treatment complications becomes important. Osteonecrosis (ON) is a serious disabling complication in treated ALL patients. The aim of the study was to define the frequency of ON identified by magnetic resonance imaging (MRI) and to study the risk factors for ON. PATIENTS AND METHODS The frequency of ON was evaluated retrospectively in 858 patients with ALL who were diagnosed at Children's Cancer Hospital of Egypt from January 2009 to December 2012. Patients were treated with St Jude Total Therapy Study XV. RESULTS Of 858 patients evaluated, 665 were eligible for the study and 65 (9.7%) developed ON. The cumulative 5-year incidence of ON was 11.96% (SE, 0.131%). Of 154 patients aged 10 years and older, 40 (26%) developed ON. The mean age of patients with ON was 10.7 years. The prognostic factors with a significant relationship with ON were age 10 years and older (P = 0.0001) and intermediate-/high-risk group (P = 0.0001). However, gender did not have a significant relationship. At the onset of ON, the mean cumulative dexamethasone dose was 796 mg/m2 , and the mean total corticosteroid dose, calculated as prednisolone equivalence, was 6,431 mg/m2 . Out of 43 patients who developed ON while on corticosteroid therapy, 36 (84%) required dexamethasone dose modification and/or discontinuation. CONCLUSION The frequency of ON among the studied patients was 9.7%. Risk factors with a significant association with ON were older age and more intensive corticosteroid therapy.
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Affiliation(s)
- Nesreen Ali
- Lecturer of Pediatric Oncology and Hematology, National Cancer Institute (NCI), Cairo University, Egypt, Consultant of Pediatric Oncology and Hematology, Children Cancer Hospital, Egypt
| | - Seham Gohar
- Consultant of Pediatric Oncology and Hematology Children Cancer Hospital, Egypt
| | - Iman Zaky
- Professor of Radiodiagnosis, National Cancer Institute (NCI), Cairo University, Egypt, Consultant of Radiodiagnosis, Children Cancer Hospital, Egypt
| | - Ahmed Elghoneimy
- Professor of Orthopedic Surgery, Kasr Al Eeiny, Cairo University, Egypt, Consultant of Orthopedic Surgery, Children Cancer Hospital, Egypt
| | - Sarah Youssef
- Board Certified Oncology Pharmacist, Children Cancer Hospital, Egypt
| | - Gehad Sameer
- Clinical Pharmacy, Children Cancer Hospital, Egypt
| | - Dina Yassin
- Professor of Clinical Pathology, National Cancer Institute (NCI), Cairo University, Egypt, Consultant of Clinical Pathology, Children Cancer Hospital, Egypt
| | - Sherine Salem
- Assistant Professor of Clinical Pathology, National Cancer Institute (NCI), Cairo University, Egypt, Consultant of Clinical Pathology, Children Cancer Hospital, Egypt
| | - Hadeel Magdi
- Clinical Research, Children Cancer Hospital, Egypt
| | - Iman Sidhom
- Professor of Pediatric Oncology and Hematology, National Cancer Institute (NCI), Cairo University, Egypt, Consultant of Pediatric Oncology and Hematology Children Cancer Hospital, Egypt
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Parasole R, Valsecchi MG, Silvestri D, Locatelli F, Barisone E, Petruzziello F, Putti MC, Micalizzi C, Colombini A, Mura R, Mina T, Testi AM, Notarangelo LD, Santoro N, Casini T, Consarino C, Nigro LL, Ziino O, Giagnuolo G, Rizzari C, Conter V. Correspondence: Osteonecrosis in childhood acute lymphoblastic leukemia: a retrospective cohort study of the Italian Association of Pediatric Haemato-Oncology (AIEOP). Blood Cancer J 2018; 8:115. [PMID: 30442887 PMCID: PMC6237817 DOI: 10.1038/s41408-018-0150-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/02/2018] [Accepted: 10/23/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Rosanna Parasole
- Department of Pediatric Hemato-Oncology, A.O.R.N. Santobono-Pausilipon, Naples, Italy.
| | - Maria G Valsecchi
- Center of Biostatistics for Clinical Epidemiology, Department of Health Science, University of Milano-Bicocca, Milan, Italy
| | - Daniela Silvestri
- Center of Biostatistics for Clinical Epidemiology, Department of Health Science, University of Milano-Bicocca, Milan, Italy.,Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation/ASST Monza, Monza, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology-Oncology, IRCCS "Bambino Gesù" Children's Hospital, Rome, and Department of Pediatrics, University of Pavia, Pavia, Italy
| | - Elena Barisone
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Fara Petruzziello
- Department of Pediatric Hemato-Oncology, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - M Caterina Putti
- Department of Woman and Child Health, Laboratory of Haematology-Oncology, University of Padova, Padova, Italy
| | - Concetta Micalizzi
- Department of Pediatric Hematology-Oncology, IRCCS "Giannina Gaslini" Children's Hospital, Genoa, Italy
| | - Antonella Colombini
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation/ASST Monza, Monza, Italy
| | - Rossella Mura
- Pediatric Hematology-Oncology, Ospedale Microcitemico, Cagliari, Italy
| | - Tommaso Mina
- Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna M Testi
- Department of Cellular Biotechnologies and Hematogy, "Sapienza" University of Rome, Rome, Italy
| | | | - Nicola Santoro
- UOC di Pediatria ad indirizzo Oncoematologico Ospedaliera, Policlinico di Bari, Bari, Italy
| | - Tommaso Casini
- Pediatric Hematology-Oncology, IRCCS Meyer Children's Hospital, Florence, Italy
| | - Caterina Consarino
- Pediatric Hematology-Oncology, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - Luca Lo Nigro
- Center of Pediatric Hemato-Oncology, Azienda Policlinico - OVE, Catania, Italy
| | - Ottavio Ziino
- Department of Pediatric Haemato-Oncology, ARNAS Civico e Di Cristina, Palermo, Italy
| | - Giovanna Giagnuolo
- Department of Pediatric Hemato-Oncology, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Carmelo Rizzari
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation/ASST Monza, Monza, Italy
| | - Valentino Conter
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation/ASST Monza, Monza, Italy
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Barakat E, Kirchgesner T, Triqueneaux P, Galant C, Stoenoiu M, Lecouvet FE. Whole-Body Magnetic Resonance Imaging in Rheumatic and Systemic Diseases. Magn Reson Imaging Clin N Am 2018; 26:581-597. [DOI: 10.1016/j.mric.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Symptomatic osteonecrosis as a treatment complication in Hodgkin lymphoma: an analysis of the German Hodgkin Study Group (GHSG). Leukemia 2018; 33:439-446. [PMID: 30131583 DOI: 10.1038/s41375-018-0240-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/12/2018] [Accepted: 07/17/2018] [Indexed: 12/14/2022]
Abstract
The majority of patients with Hodgkin Lymphoma (HL) can be cured with stage and risk adapted treatment today. Therefore, current research focuses on reducing long-term sequelae of treatment. Osteonecrosis (ON) is a severe long-term complication of HL treatment which has so far not been systematically evaluated. Hence, we investigated incidence, risk factors and timing of symptomatic ON in HL patients. Further endpoints included localization, intervention and outcome of ON. We included all qualified HL patients of the randomized German Hodgkin Study Group trials HD10-15 and HD18, recruited between 05/1998 and 07/2014 and aged from 16 to 60 years. Among 11 330 patients, 66 developed symptomatic ON after first-line treatment, 83.3% within three years. The incidence of symptomatic ON was 0.2% in early-stage HL and 1.0% in advanced-stage HL. Logistic regression revealed the total cumulative corticosteroid dose to be a strong risk factor interacting with younger age. Male sex additionally increased the risk of symptomatic ON. The prognostic value of the corresponding logistic regression model was rather high (AUC = 0.78). Other tested potential risk factors including obesity, IPS and radiotherapy did not further increase the risk of ON. Further development of current treatment protocols should aim to reduce the cumulative corticosteroid dose.
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Recent Developments in Adolescent and Young Adult (AYA) Acute Lymphoblastic Leukemia. Curr Hematol Malig Rep 2018; 13:100-108. [DOI: 10.1007/s11899-018-0442-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alguacil Pinel J, Vila Vives P, Salom Taverner M. Avascular necrosis of the femoral head in patients treated for leukaemia. Assessment of the need for a diagnostic protocol. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Theruvath AJ, Ilivitzki A, Muehe A, Theruvath J, Gulaka P, Kim C, Luna-Fineman S, Sakamoto KM, Yeom KW, Yang P, Moseley M, Chan F, Daldrup-Link HE. A PET/MR Imaging Approach for the Integrated Assessment of Chemotherapy-induced Brain, Heart, and Bone Injuries in Pediatric Cancer Survivors: A Pilot Study. Radiology 2017; 285:971-979. [PMID: 28777701 DOI: 10.1148/radiol.2017170073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session. Materials and Methods Three teams of experts in neuroimaging, cardiac imaging, and bone imaging were tasked to develop a 20-30-minute PET/MR imaging protocol for detection of chemotherapy-induced tissue injuries of the brain, heart, and bone. In an institutional review board-approved, HIPAA-compliant, prospective study from April to July 2016, 10 pediatric cancer survivors who completed chemotherapy underwent imaging of the brain, heart, and bone with a 3-T PET/MR imager. Cumulative chemotherapy doses and clinical symptoms were correlated with the severity of MR imaging abnormalities by using linear regression analyses. MR imaging measures of brain perfusion and metabolism were compared among eight patients who were treated with methotrexate and eight untreated age-matched control subjects by using Wilcoxon rank-sum tests. Results Combined brain, heart, and bone examinations were completed within 90 minutes. Eight of 10 cancer survivors had abnormal findings on brain, heart, and bone images, including six patients with and two patients without clinical symptoms. Cumulative chemotherapy doses correlated significantly with MR imaging measures of left ventricular ejection fraction and end-systolic volume, but not with the severity of brain or bone abnormalities. Methotrexate-treated cancer survivors had significantly lower cerebral blood flow and metabolic activity in key brain areas compared with control subjects. Conclusion The feasibility of a single examination for assessment of chemotherapy-induced injuries of the brain, heart, and joints was shown. Earlier detection of tissue injuries may enable initiation of timely interventions and help to preserve long-term health of pediatric cancer survivors. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Ashok J Theruvath
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Anat Ilivitzki
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Anne Muehe
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Johanna Theruvath
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Praveen Gulaka
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Christine Kim
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Sandra Luna-Fineman
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Kathleen M Sakamoto
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Kristen W Yeom
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Phillip Yang
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Michael Moseley
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Frandics Chan
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
| | - Heike E Daldrup-Link
- From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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Alguacil Pinel J, Vila Vives P, Salom Taverner M. Avascular necrosis of the femoral head in patients treated for leukaemia. Assessment of the need for a diagnostic protocol. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:331-338. [PMID: 28728961 DOI: 10.1016/j.recot.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/03/2017] [Accepted: 05/13/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the incidence of avascular necrosis of the hip in leukaemia patients treated in our hospital with high doses of corticosteroids in order to evaluate the necessity for an early detection protocol. MATERIAL AND METHODS Observational-descriptive and retrospective study from 2005 to 2016 of 253 patients diagnosed with paediatric leukaemia. Patients with musculoskeletal pathology were identified and patients with avascular necrosis were analysed. RESULTS A total of 26 patients (10%) had musculoskeletal symptoms. Three patients with avascular necrosis (1.2%) were analysed. One girl, 7 years old, was treated conservatively with traction - suspension and discharge. Two boys, an 11 and a 15.4 year-old,who developed graft-versus-host disease secondary to bone marrow transplantation, and whose treatment included high doses of corticosteroids, developed avascular necrosis of the hip. One was treated with bisphosphonates and forage and the other ended up with a total hip arthroplasty. DISCUSSION The occurrence of musculoskeletal symptoms during the treatment of leukaemia is different according to the bibliographic series (0.43 -12.6%). Some authors observe an increased risk in female patients between the ages of 10 and 17. A retrospective study reveals that there is a delay of 3.9 months in the diagnosis of CAP since the onset of pain. Other authors relate NAV to loading joints, age and high doses of corticosteroids. CONCLUSION Based on the low incidence of avascular necrosis of the hip in our 14-year-old population treated for leukaemia, the creation of diagnostic protocols seems not to be necessary. However, close monitoring of patients with potential risk factors recognized in the literature, is advisable.
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Affiliation(s)
- J Alguacil Pinel
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - P Vila Vives
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M Salom Taverner
- Unidad de Ortopedia infantil, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España.
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Albano D, Patti C, Sconfienza LM, Galia M. Whole-body MRI in the early detection of multifocal osteonecrosis. Br J Radiol 2017; 90:20170240. [PMID: 28707528 DOI: 10.1259/bjr.20170280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Domenico Albano
- 1 Department of Radiology, Di.Bi.Med., University of Palermo , Palermo , Italy
| | - Caterina Patti
- 2 Department of Hematology I, Azienda Ospedali Riuniti Villa Sofia-Cervello , Palermo , Italy
| | - Luca Maria Sconfienza
- 3 Department of Biomedical Sciences for Health, University of Milano , Milano , Italy.,4 Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi Milano , Italy
| | - Massimo Galia
- 1 Department of Radiology, Di.Bi.Med., University of Palermo , Palermo , Italy
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Portera MV, Karol SE, Smith C, Yang W, Cheng C, Neel MD, Pui CH, Relling MV, Kaste SC. Osteonecrosis is unrelated to hip anatomy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26407. [PMID: 28035753 PMCID: PMC5596390 DOI: 10.1002/pbc.26407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 12/31/2022]
Abstract
Osteonecrosis is a debilitating toxicity associated with acute lymphoblastic leukemia (ALL) treatment. A recent report associated interindividual differences in hip anatomy with the development of idiopathic osteonecrosis in adults. To evaluate the impact of hip anatomy on the development of therapy-related osteonecrosis, we retrospectively evaluated the femoral neck-shaft angle, femoral neck offset, and lateral center-edge angle using x-rays of 18 osteonecrosis cases and 46 control children treated for newly diagnosed ALL on a single protocol. Despite adequate statistical power, we found no association between hip anatomy and osteonecrosis. Investigation of other factors contributing to ALL-associated osteonecrosis is warranted.
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Affiliation(s)
- Mary V. Portera
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Seth E. Karol
- Department of Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Colton Smith
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Wenjian Yang
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Cheng Cheng
- Department of Biostatics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Michael D. Neel
- Department of Orthopaedics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Mary V. Relling
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sue C. Kaste
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Kuhlen M, Kunstreich M, Krull K, Meisel R, Borkhardt A. Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge. Blood Adv 2017; 1:981-994. [PMID: 29296741 PMCID: PMC5737600 DOI: 10.1182/bloodadvances.2017007286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/18/2017] [Indexed: 01/19/2023] Open
Abstract
Osteonecrosis (ON) represents one of the most common and debilitating sequelae of antileukemic treatment in children and adolescents with acute lymphoblastic leukemia (ALL). Systematic screening strategies can focus on early detection and intervention to prevent ON from progressing to stages associated with pain and functional impairment. These strategies hold promise for reducing ON-associated morbidity without the risk of impairing leukemia control. Herein, we critically reviewed clinical data on pharmacological, nonpharmacological/nonsurgical, and surgical (including cellular) treatment options for ON, which are covered in the literature and/or are conceivable based on the supposed underlying ON pathophysiology. Prevention of ON progression is of paramount importance, and attempts seem to be more effective in early (precollapse) disease status than in late-stage (collapse) ON. Based on the results of ongoing prospective magnetic resonance imaging screening studies, which will hopefully identify those patients with a high risk of ON progression and debilitating sequelae, prospective interventional studies are urgently needed. Although there is still a lack of high-quality studies, based on currently available data, core decompression surgery combined with cellular therapies (eg, employing mesenchymal stem cells) appears most promising for preventing joint infraction in children at high risk of developing late-stage ON.
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Affiliation(s)
- Michaela Kuhlen
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Marina Kunstreich
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Kathinka Krull
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Roland Meisel
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
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Raissaki M, Demetriou S, Spanakis K, Skiadas C, Katzilakis N, Velivassakis EG, Stiakaki E, Karantanas AH. Multifocal bone and bone marrow lesions in children - MRI findings. Pediatr Radiol 2017; 47:342-360. [PMID: 28004130 DOI: 10.1007/s00247-016-3737-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/13/2016] [Accepted: 10/18/2016] [Indexed: 12/20/2022]
Abstract
Polyostotic bone and bone marrow lesions in children may be due to various disorders. Radiographically, lytic lesions may become apparent after loss of more than 50% of the bone mineral content. Scintigraphy requires osteoblastic activity and is not specific. MRI may significantly contribute to the correct diagnosis and management. Accurate interpretation of MRI examinations requires understanding of the normal conversion pattern of bone marrow in childhood and of the appearances of red marrow rests and hyperplasia. Differential diagnosis is wide: Malignancies include metastases, multifocal primary sarcomas and hematological diseases. Benign entities include benign tumors and tumor-like lesions, histiocytosis, infectious and inflammatory diseases, multiple stress fractures/reactions and bone infarcts/ischemia.
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Affiliation(s)
- Maria Raissaki
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece.
| | - Stelios Demetriou
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | - Konstantinos Spanakis
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | - Christos Skiadas
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | - Nikolaos Katzilakis
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | | | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
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Krull K, Kunstreich M, Klasen-Sansone J, Kloetgen A, Gruener F, Escherich G, Bleckmann K, Moericke A, Schrappe M, Jorch N, Steinbach D, Classen CF, Guggemos A, Kolb R, Klee D, Borkhardt A, Kuhlen M. Osteonecrosis develops independently from radiological leukemic infiltration of bone in adolescents with acute lymphoblastic leukemia – first findings of the OPAL trial. Leuk Lymphoma 2017; 58:2363-2369. [DOI: 10.1080/10428194.2017.1280605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Kathinka Krull
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, Center for Child and Adolescent Health, University of Duesseldorf, Duesseldorf, Germany
| | - Marina Kunstreich
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, Center for Child and Adolescent Health, University of Duesseldorf, Duesseldorf, Germany
| | - Janina Klasen-Sansone
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Andreas Kloetgen
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, Center for Child and Adolescent Health, University of Duesseldorf, Duesseldorf, Germany
- Department of Pathology, NYU School of Medicine, New York, NY, USA
| | - Franziska Gruener
- Clinic of Pediatric Hematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Escherich
- Clinic of Pediatric Hematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten Bleckmann
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Anja Moericke
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Martin Schrappe
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Norbert Jorch
- Department of Pediatrics, Evangelical Hospital, Bielefeld, Germany
| | - Daniel Steinbach
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | | | - Andreas Guggemos
- Department of Pediatric Oncology/Hematology, Children’s Hospital Cologne, Cologne, Germany
| | - Reinhard Kolb
- Pediatric Hematology and Oncology, Elisabeth-Hospital Oldenburg, Oldenburg, Germany
| | - Dirk Klee
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, Center for Child and Adolescent Health, University of Duesseldorf, Duesseldorf, Germany
| | - Michaela Kuhlen
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, Center for Child and Adolescent Health, University of Duesseldorf, Duesseldorf, Germany
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Amin NL, Feltbower R, Kinsey S, Vora A, James B. Osteonecrosis in patients with acute lymphoblastic leukaemia: a national questionnaire study. BMJ Paediatr Open 2017; 1:e000122. [PMID: 29637145 PMCID: PMC5862222 DOI: 10.1136/bmjpo-2017-000122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To establish prevalence, management and long-term outcomes of osteonecrosis (ON) in young people diagnosed with acute lymphoblastic leukaemia (ALL) between 2003 and 2011. DESIGN SETTING PARTICIPANTS This study assessed ON in 3113 patients aged 1-24 years who participated in the UK national leukaemia study UKALL 2003. UKALL 2003 recruited patients in 40 UK hospitals between 2003 and 2011 and included patients between ages 1 and 25 diagnosed with ALL. RESULTS 170 patients were diagnosed with ON, giving a prevalence of 5.5%. The multivariable analysis showed that the risk of ON was highest for children aged between 10 and 20 years (ages 10-15 years, OR 23.7, 95% CI 14.8 to 38.0; ages 16-20 years, OR 22.5, 95% CI 12.7 to 39.8, compared with age <10 years). Among ethnic groups, Asian patients had the highest risk of ON (OR 1.92, 95% CI 1.1 to 3.6, compared with White patients). Eighty-five per cent of patients with ON had multifocal ON. Thirty-eight per cent of patients with ON required surgery and 19% of patients with ON required a hip replacement. Fifteen per cent of patients who had surgery still describe significant disability or use of a wheelchair. CONCLUSIONS ON has considerable morbidity for patients being treated for ALL, with a high burden of surgery. Age and ethnicity were found to be the most significant risk factors for development of ON, with Asian patients and patients aged 10-20 years at diagnosis of ALL at greatest risk. These results will help risk stratify patients at diagnosis of ALL, and help tailor future prospective studies in this area.
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Affiliation(s)
- Nadia Laila Amin
- Paediatric haematology, Leeds Children's Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | | | - Sally Kinsey
- Paediatric haematology, Leeds Children's Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | - Ajay Vora
- Paediatric haematology, Great Ormond Street Hospital, London, UK
| | - Beki James
- Paediatric haematology, Leeds Children's Hospital, Leeds, UK
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McNeer JL, Bleyer A, Conter V, Stock W. Acute Lymphoblastic Leukemia. CANCER IN ADOLESCENTS AND YOUNG ADULTS 2017. [DOI: 10.1007/978-3-319-33679-4_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Littooij AS, Kwee TC, Enríquez G, Verbeke JIML, Granata C, Beishuizen A, de Lange C, Zennaro F, Bruin MCA, Nievelstein RAJ. Whole-body MRI reveals high incidence of osteonecrosis in children treated for Hodgkin lymphoma. Br J Haematol 2016; 176:637-642. [PMID: 27891588 DOI: 10.1111/bjh.14452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/12/2016] [Indexed: 11/26/2022]
Abstract
Osteonecrosis is a well-recognized complication in patients treated with corticosteroids. The incidence of osteonecrosis in children treated for Hodgkin lymphoma is unknown because prospective whole-body magnetic resonance imaging (MRI) studies are lacking in this patient population. Paediatric patients with newly diagnosed Hodgkin lymphoma who were treated according to a uniform paediatric Hodgkin protocol were eligible for inclusion in this prospective study. Whole-body MRI was performed in all 24 included patients (mean age 15·1 years, 12 girls) both before treatment and after 2 cycles of chemotherapy, and in 16 patients after completion of chemotherapy. Osteonecrosis was identified in 10 patients (41·7%, 95% confidence interval: 22·0-61·4%), with a total of 56 osteonecrotic sites. Osteonecrosis was detected in 8 patients after 2 cycles of OEPA (vincristine, etoposide, prednisone, doxorubicin), and in 2 additional patients after completion of chemotherapy. Epiphyseal involvement of long bones was seen in 4 of 10 children. None of the patients with osteonecrosis had any signs of bone collapse at the times of scanning. Whole-body MRI demonstrates osteonecrosis to be a common finding occurring during therapy response assessment of paediatric Hodgkin lymphoma. Detection of early epiphyseal osteonecrosis could allow for treatment before bone collapse and joint damage may occur.
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Affiliation(s)
- Annemieke S Littooij
- Department of Radiology, University Medical Centre Utrecht-Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands
| | - Thomas C Kwee
- Department of Radiology, University Medical Centre Utrecht-Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands
| | - Goya Enríquez
- Department of Paediatric Radiology, Hospital Materno-Infantil Vall d'Hebron, Barcelona, Spain
| | | | - Claudio Granata
- Department of Radiology, IRCCS Giannina Gaslini Hospital, Genoa, Italy
| | - Auke Beishuizen
- Department of Paediatric Oncology/Haematology, Erasmus MC University Medical Centre-Sophia's Children's Hospital, Rotterdam, the Netherlands
| | - Charlotte de Lange
- Department of Diagnostic Imaging and Intervention, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Floriana Zennaro
- Department of Paediatric Radiology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Marrie C A Bruin
- Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands
| | - Rutger A J Nievelstein
- Department of Radiology, University Medical Centre Utrecht-Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands
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Kunstreich M, Kummer S, Laws HJ, Borkhardt A, Kuhlen M. Osteonecrosis in children with acute lymphoblastic leukemia. Haematologica 2016; 101:1295-1305. [PMID: 27742768 DOI: 10.3324/haematol.2016.147595] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/23/2016] [Indexed: 11/09/2022] Open
Abstract
The morbidity and toxicity associated with current intensive treatment protocols for acute lymphoblastic leukemia in childhood become even more important as the vast majority of children can be cured and become long-term survivors. Osteonecrosis is one of the most common therapy-related and debilitating side effects of anti-leukemic treatment and can adversely affect long-term quality of life. Incidence and risk factors vary substantially between study groups and therapeutic regimens. We therefore analyzed 22 clinical trials of childhood acute lymphoblastic leukemia in terms of osteonecrosis incidence and risk factors. Adolescent age is the most significant risk factor, with patients >10 years old at the highest risk. Uncritical modification or even significant reduction of glucocorticoid dosage cannot be recommended at this stage. A novel and innovative approach to reduce osteonecrosis-associated morbidity might be systematic early screening for osteonecrosis by serial magnetic resonance images. However, discriminating patients at risk of functional impairment and debilitating progressive joint disease from asymptomatic patients still remains challenging.
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Affiliation(s)
- Marina Kunstreich
- University of Duesseldorf, Medical Faculty, Department of Pediatric Oncology, Hematology, and Clinical Immunology, Center for Child and Adolescent Health, Germany
| | - Sebastian Kummer
- University of Duesseldorf, Medical Faculty, Department of General Pediatrics, Neonatology and Pediatric Cardiology, Center for Child and Adolescent Health, Germany
| | - Hans-Juergen Laws
- University of Duesseldorf, Medical Faculty, Department of Pediatric Oncology, Hematology, and Clinical Immunology, Center for Child and Adolescent Health, Germany
| | - Arndt Borkhardt
- University of Duesseldorf, Medical Faculty, Department of Pediatric Oncology, Hematology, and Clinical Immunology, Center for Child and Adolescent Health, Germany
| | - Michaela Kuhlen
- University of Duesseldorf, Medical Faculty, Department of Pediatric Oncology, Hematology, and Clinical Immunology, Center for Child and Adolescent Health, Germany
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Amin NL, James RM, Phillips R. QUESTION 1: Should we be using bisphosphonates for osteonecrosis complicating childhood acute lymphoblastic leukaemia? Arch Dis Child 2016; 101:287-90. [PMID: 26768828 DOI: 10.1136/archdischild-2015-309934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/16/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Nadia Laila Amin
- Department of Paediatric Endocrinology, Leeds General Infirmary, Leeds, West Yorkshire, UK Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, York, UK
| | - Rebecca M James
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, York, UK
| | - Robert Phillips
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, York, UK Centre for Reviews and Dissemination, York, UK
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Padhye B, Dalla-Pozza L, Little D, Munns C. Incidence and outcome of osteonecrosis in children and adolescents after intensive therapy for acute lymphoblastic leukemia (ALL). Cancer Med 2016; 5:960-7. [PMID: 26792372 PMCID: PMC4864825 DOI: 10.1002/cam4.645] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 12/14/2015] [Accepted: 12/27/2015] [Indexed: 12/22/2022] Open
Abstract
Osteonecrosis (ON), a significant complication following treatment of acute lymphoblastic leukemia (ALL), has a profound impact on quality of life of ALL survivors. We studied incidence and outcome of ON in patients treated on or according to Australian and New Zealand Children's Haematology/ Oncology Group (ANZCHOG) study 8 at The Children's Hospital at Westmead. The study involved retrospective chart review of the patients. ON was defined by development of symptoms and confirmed by magnetic resonance imaging. From 2002-2011, 251 patients (143M, 108F, 59 Standard Risk (SR), 159 Medium Risk (MR) 5 High Risk (HR), and 28 Very high risk (VHR)) were treated according to study 8. Eighteen (7M, 11F, 2 SR, 12 MR, 4 VHR) patients developed ON (7.2%). Median age at diagnosis was 13.05 years(4.3-16.7). Incidence of ON in patients > 10 years at diagnosis was 29%. Six out of 18 patients developed ON after allogeneic stem cell transplantation. Median time from diagnosis to the development of ON following chemotherapy for ALL was 1.15 years (range 0.25-2.12). Most patients were treated with intravenous Zoledronic acid. At last follow-up, three patients had undergone arthroplasty, two patients were symptom free, and the remaining 13 patients reported persistent pain with activity. A majority of patients with ON of the hips had radiological progression. Overall, 7% of patients with ALL developed ON. Age >10 years was the most important risk factor. At last follow-up, 70% of patients had persistent symptoms. Although Zoledronic acid improved pain, most patients with ON of the hips had radiological progression.
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Affiliation(s)
- Bhavna Padhye
- Department of Oncology, The Children's Hospital at Westmead, Sydney, Australia
| | - Luciano Dalla-Pozza
- Department of Oncology, The Children's Hospital at Westmead, Sydney, Australia
| | - David Little
- Department Orthopaedics, The Children's Hospital at Westmead, Sydney, Australia
| | - Craig Munns
- Department of Endocrinology, The Children's Hospital at Westmead, Sydney, Australia
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den Hoed MAH, Pluijm SMF, te Winkel ML, de Groot-Kruseman HA, Fiocco M, Hoogerbrugge P, Leeuw JA, Bruin MCA, van der Sluis IM, Bresters D, Lequin MH, Roos JC, Veerman AJP, Pieters R, van den Heuvel-Eibrink MM. Aggravated bone density decline following symptomatic osteonecrosis in children with acute lymphoblastic leukemia. Haematologica 2015; 100:1564-70. [PMID: 26405155 DOI: 10.3324/haematol.2015.125583] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/24/2015] [Indexed: 11/09/2022] Open
Abstract
Osteonecrosis and decline of bone density are serious side effects during and after treatment of childhood acute lymphoblastic leukemia. It is unknown whether osteonecrosis and low bone density occur together in the same patients, or whether these two osteogenic side-effects can mutually influence each other's development. Bone density and the incidence of symptomatic osteonecrosis were prospectively assessed in a national cohort of 466 patients with acute lymphoblastic leukemia (4-18 years of age) who were treated according to the dexamethasone-based Dutch Child Oncology Group-ALL9 protocol. Bone mineral density of the lumbar spine (BMDLS) (n=466) and of the total body (BMDTB) (n=106) was measured by dual X-ray absorptiometry. Bone density was expressed as age- and gender-matched standard deviation scores. Thirty patients (6.4%) suffered from symptomatic osteonecrosis. At baseline, BMDLS and BMDTB did not differ between patients who did or did not develop osteonecrosis. At cessation of treatment, patients with osteonecrosis had lower mean BMDLS and BMDTB than patients without osteonecrosis (respectively, with osteonecrosis: -2.16 versus without osteonecrosis: -1.21, P<0.01 and with osteonecrosis: -1.73 versus without osteonecrosis: -0.57, P<0.01). Multivariate linear models showed that patients with osteonecrosis had steeper BMDLS and BMDTB declines during follow-up than patients without osteonecrosis (interaction group time, P<0.01 and P<0.01). We conclude that bone density status at the diagnosis of acute lymphoblastic leukemia does not seem to influence the occurrence of symptomatic osteonecrosis. Bone density declines from the time that osteonecrosis is diagnosed; this suggests that the already existing decrease in bone density during acute lymphoblastic leukemia therapy is further aggravated by factors such as restriction of weight-bearing activities and destruction of bone architecture due to osteonecrosis. Osteonecrosis can, therefore, be considered a risk factor for low bone density in children with acute lymphoblastic leukemia.
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Affiliation(s)
- Marissa A H den Hoed
- Department of Pediatric Oncology/ Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands Princess Maxima Center, Utrecht, The Netherlands
| | - Saskia M F Pluijm
- Department of Pediatric Oncology/ Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands Princess Maxima Center, Utrecht, The Netherlands
| | - Mariël L te Winkel
- Department of Pediatric Oncology/ Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Martha Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Utrecht, The Netherlands
| | - Peter Hoogerbrugge
- Department of Pediatric Hemato-Oncology, Radboud University Medical Center Nijmegen, Utrecht, The Netherlands
| | - Jan A Leeuw
- Dutch Childhood Oncology Group, The Hague, The Netherlands Beatrix Children's Hospital, University of Groningen, Utrecht, The Netherlands
| | - Marrie C A Bruin
- Dutch Childhood Oncology Group, The Hague, The Netherlands University Medical Center, Utrecht, The Netherlands
| | - Inge M van der Sluis
- Department of Pediatric Oncology/ Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dorien Bresters
- Dutch Childhood Oncology Group, The Hague, The Netherlands Leiden University Medical Center, Utrecht, The Netherlands
| | - Maarten H Lequin
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Jan C Roos
- Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Anjo J P Veerman
- Dutch Childhood Oncology Group, The Hague, The Netherlands Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Rob Pieters
- Princess Maxima Center, Utrecht, The Netherlands
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