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Al-Mashdali AF, Al-Dubai HN, Yassin MA. Avascular necrosis in patients with chronic myeloid leukemia: A systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022017. [PMID: 35315390 PMCID: PMC8972877 DOI: 10.23750/abm.v93i1.12270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/23/2022]
Abstract
Objective: Avascular necrosis (AVN)has been encountered in hematological malignancies; nonetheless, AVN is extremely uncommon in patients with chronic myeloid leukemia (CML). This review aims to describe the pathophysiology, clinical characteristics, and outcomes of AVN in CML. To our knowledge, this is the first systematic review of this topic. METHODS We searched PubMed and Google Scholar for the case reports and series of patients with CML who developed AVN from inception to July 2021. RESULTS We found 21 cases of AVN in CML patients,17 cases with avascular necrosis of the femoral head (AVNFH), and four cases with osteonecrosis of the jaw (ONJ). The median age was 39 years with an almost equal distribution between males and females (ratio of 1:1). AVN related to CML management has been linked to tyrosine kinase inhibitors (TKIs) and standard interferon-alpha (IFN-α) therapies. Only six (out of 17) patients who developed AVN of the femoral head eventually required a hip replacement, and one (out of 17) developed a recurrent episode of AVNFH. All the reported cases of CML with osteonecrosis of the jaw were associated with TKIs therapy. CONCLUSION Clinician should consider AVN in any CML patient complaining of either hip or jaw pain. IFN-α and TKI therapies can predispose to AVN in CML patients. Further studies are required for a better understanding of this condition in CML.
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Affiliation(s)
| | - Husam N. Al-Dubai
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A. Yassin
- National Center for Cancer Care and Research, Department of Oncology, Hematology and BMT Section, Hamad Medical Corporation, Doha, Qatar
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Zhang L, Fan Y, Zhang Y, Chen X, Liu Y. Comparison of sartorius muscle-pedicle and circumflex iliac deep bone flap grafts in the treatment of early non-traumatic osteonecrosis of femoral head in young adults. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:255-259. [PMID: 31031129 PMCID: PMC6739257 DOI: 10.1016/j.aott.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/06/2019] [Accepted: 04/07/2019] [Indexed: 11/17/2022]
Abstract
Objective The aim of this study was to retrospectively compare and evaluate the midterm curative effect of two different bone flap grafts in the treatment of early non-traumatic osteonecrosis of the femoral head (ONFH). Methods A total of 180 patients (199 hips) with early non-traumatic ONFH received surgical treatment by sartorius muscle-pedicle bone flap graft (SMBF) (104 patients, 64 males and 40 females; mean age 34.67 ± 3.24 years) or circumflex iliac deep bone flap graft (CIDBF) (76 patients, 44 males and 32 females; mean age: 35.54 ± 3.37 years) from July 2004 to July 2009. The comparison between the groups was made with Harris score before and after surgery, length of incision, operative time, amount of bleeding, postoperative X-ray. Association Research Circulation Osseous (ARCO) staging was performed. Results The preoperative Harris hip score of two groups were 68.26 ± 1.26 and 69.35 ± 1.31, respectively. Patients' ARCO staging indicated 36 hips of stage IIa, 115 hips of stage IIb and 48 hips of stage IIc. The etiology of ONFH mainly including hormones (93 patients), alcohol (64 patients) and other (23 patients). The mean follow-up time of SMBF and CIDBF groups were (51.78 ± 2.35) and (52.73 ± 3.71) months, respectively. The time of removing sutures, operation time, amount of bleeding and length of incision in SMBF group were superior to those in the CIDBF group, and those differences between the SMBF and CIDBF groups were not significant (all p values > 0.28). The Harris score between the two groups was similar after operation and postoperative 12 month, and the difference was not statistically significant (p > 0.05), whereas the difference of the postoperative 24 and 48 months was statistically significant (p ˂ 0.05). X-ray analysis showed improvement of osteonecrosis in both two groups after surgery, and as time went on, the total hip amount decreased, the replacement amount increased. Conclusion Both bone flap grafts appear to be effective methods for treatment of early osteonecrosis of femoral head (ARCOⅡ), and the SMBF is a relatively simple technique and easy for mastering, and it is a reliable method for clinical application. Level of evidence Level III, Therapeutic Study.
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Affiliation(s)
- Leilei Zhang
- Luoyang Orthopedic Hospital of Henan Province, Orthopedics Hospital of Henan Province, Luoyang, PR China
| | - Yanan Fan
- Luoyang Orthopedic Hospital of Henan Province, Orthopedics Hospital of Henan Province, Luoyang, PR China
| | - Ying Zhang
- Luoyang Orthopedic Hospital of Henan Province, Orthopedics Hospital of Henan Province, Luoyang, PR China
| | - Xiantao Chen
- Luoyang Orthopedic Hospital of Henan Province, Orthopedics Hospital of Henan Province, Luoyang, PR China.
| | - Youwen Liu
- Luoyang Orthopedic Hospital of Henan Province, Orthopedics Hospital of Henan Province, Luoyang, PR China.
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Dima A, Pedersen AB, Pedersen L, Baicus C, Thomsen RW. Association of common comorbidities with osteonecrosis: a nationwide population-based case-control study in Denmark. BMJ Open 2018; 8:e020680. [PMID: 29439082 PMCID: PMC5829903 DOI: 10.1136/bmjopen-2017-020680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine recent time trends in the incidence of osteonecrosis (ON) in Denmark and to investigate different common comorbidities association with ON in a population-based setting. METHODS Using Danish medical databases, we included all patients with a first-time hospital diagnosis of ON during 1995-2012. Each ON case was matched with 10 randomly selected population control subjects from general population. For all participants, we obtained a complete hospital history of comorbidities included in the CharlsonComorbidity Index 5 years preceding the inclusion date. RESULTS 4107 ON cases and 41 063 controls were included. The incidence of ON increased from 3.9 in 1995 to 5.5 in 2012 per 100 000 inhabitants. Solid cancer was the most common comorbidity, associated with an adjusted OR (aOR) for ON of 2.0 (95% CI 1.7 to 2.2). For advanced metastatic cancer, leukaemia and lymphoma, aORs of ON were 3.4 (95% CI 2.5 to 4.5), 4.3 (95% CI 2.7 to 7.0) and 5.8 (95% CI 4.3 to 7.8), respectively. Among other chronic conditions, aORs were 3.5 (95% CI 3.0 to 4.1) for connective tissue diseases and 2.3 (95% CI 2.0 to 2.7) for chronic pulmonary diseases. aORs were also increased at 2.8 (95% CI 1.9 to 4.1) and 4.5 (95% CI 2.5 to 8.2) for mild and moderate-to-severe liver disease, respectively, and 4.2 (95% CI 3.4 to 5.2) for renal disease. CONCLUSION This large population-based study provides evidence for an increasing ON incidence in the general population and documents an association between several common comorbid conditions and risk of ON.
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Affiliation(s)
- Alina Dima
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- RECIF (Réseau d' Epidémiologie Clinique International Francophone), Bucharest, Romania
| | - Alma Becic Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Cristian Baicus
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- RECIF (Réseau d' Epidémiologie Clinique International Francophone), Bucharest, Romania
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Ali AM, Mirrakhimov AE, Abboud CN, Cashen AF. Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest. Hematol Oncol 2016; 34:69-78. [PMID: 27018197 DOI: 10.1002/hon.2292] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/25/2016] [Accepted: 02/15/2016] [Indexed: 11/08/2022]
Abstract
Leukostasis is a poorly understood and life-threatening complication of acute hyperleukocytic leukemia. The incidence of hyperleukocytosis and leukostasis differs among various subtypes of leukemias. While the pathophysiology of leukostasis is not fully understood, recent research has elucidated many novel pathways that may have therapeutic implications in the future. Respiratory and neurological compromise represents the classical clinical manifestations of leukostasis. If it is not diagnosed and treated rapidly, the one-week mortality rate is approximately 40%. Targeted induction chemotherapy is an important component of the successful treatment of leukostasis, although other modalities of cytoreduction are being used and investigated. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Alaa M Ali
- Washington University School of Medicine, Department of Medicine, St. Louis, MO, USA
| | - Aibek E Mirrakhimov
- University of Kentucky College of Medicine, Department of Medicine, Lexington, KY, USA
| | - Camille N Abboud
- Washington University School of Medicine, Department of Medicine, St. Louis, MO, USA
| | - Amanda F Cashen
- Washington University School of Medicine, Department of Medicine, St. Louis, MO, USA
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Yassin MA, Moustafa AH, Nashwan AJ, Soliman AT, El Derhoubi H, Mohamed SF, Mudawi DS, ELkourashy S, Asaari DR, Gutierrez HLG, Hussein RM, Al Musharraf M, Kohla S, Elsayed A, Al-Dewik N. Dasatinib Induced Avascular Necrosis of Femoral Head in Adult Patient with Chronic Myeloid Leukemia. Clin Med Insights Blood Disord 2015; 8:19-23. [PMID: 26279632 PMCID: PMC4514172 DOI: 10.4137/cmbd.s24628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/15/2015] [Accepted: 04/29/2015] [Indexed: 11/25/2022]
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the presence of the Philadelphia (Ph) chromosome resulting from the reciprocal translocation t(9;22)(q34;q11). The molecular consequence of this translocation is the generation of the BCR-ABL fusion gene, which encodes a constitutively active protein tyrosine kinase. The oncogenic protein tyrosine kinase, which is located in the cytoplasm, is responsible for the leukemia phenotype through the constitutive activation of multiple signaling pathways involved in the cell cycle and in adhesion and apoptosis. Avascular necrosis of the femoral head (AVNFH) is not a specific disease. It occurs as a complication or secondary to various causes. These conditions probably lead to impaired blood supply to the femoral head. The diagnosis of AVNFH is based on clinical findings and is supported by specific radiological manifestations. We reported a case of a 34-year-old Sudanese female with CML who developed AVNFH after receiving dasatinib as a second-line therapy. Though the mechanism by which dasatinib can cause avascular necrosis (AVN) is not clear, it can be postulated because of microcirculatory obstruction of the femoral head. To the best of our knowledge and after extensive literature search, this is the first reported case of AVNFH induced by dasatinib in a patient with CML.
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Affiliation(s)
- Mohamed A Yassin
- National Center for Cancer Care and Research, Department of Hematology and BMT, Hamad Medical Corporation, Doha, Qatar
| | - Abbas H Moustafa
- Department of Radiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulqadir J Nashwan
- National Center for Cancer Care and Research, Department of Nursing, Hamad Medical Corporation, Doha, Qatar
| | | | - Hatim El Derhoubi
- National Center for Cancer Care and Research, Department of Hematology and BMT, Hamad Medical Corporation, Doha, Qatar
| | - Shehab F Mohamed
- National Center for Cancer Care and Research, Department of Hematology and BMT, Hamad Medical Corporation, Doha, Qatar
| | - Deena S Mudawi
- National Center for Cancer Care and Research, Department of Hematology and BMT, Hamad Medical Corporation, Doha, Qatar
| | - Sarah ELkourashy
- National Center for Cancer Care and Research, Department of Hematology and BMT, Hamad Medical Corporation, Doha, Qatar
| | - Deena-Raiza Asaari
- National Center for Cancer Care and Research, Department of Nursing, Hamad Medical Corporation, Doha, Qatar
| | - Hope-Love G Gutierrez
- National Center for Cancer Care and Research, Department of Nursing, Hamad Medical Corporation, Doha, Qatar
| | - Radwa M Hussein
- National Center for Cancer Care and Research, Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Al Musharraf
- National Center for Cancer Care and Research, Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Samah Kohla
- Department of Pathology, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elsayed
- Orthopedic and Musculoskeletal Oncology, Hamad Medical Corporation, Doha, Qatar
| | - Nader Al-Dewik
- Qatar Medical Genetic Center, Hamad Medical Corporation, Doha, Qatar
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Kumar S, Bansal D, Prakash M, Sharma P. Avascular necrosis of femoral head as the initial manifestation of CML. Pediatr Hematol Oncol 2014; 31:568-73. [PMID: 24087840 DOI: 10.3109/08880018.2013.831961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 12-year-old female is reported who presented with right hip pain for 6 months. With massive splenohepatomegaly and leukocytosis, CML was suspected and confirmed on bone-marrow examination and cytogenetics. Further investigations confirmed avascular necrosis (AVN) of the right femoral head. CML was treated by hydroxyurea, followed by imatinib. AVN was managed conservatively; patient demonstrated progressive improvement, though a mild limp in the gait was persisting at 22 months. AVN as the initial manifestation of CML is a rarity. Leukostasis is considered to be the pathophysiological mechanism. In view of the rarity, a case is reported, along with compilation of previously reported cases.
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Affiliation(s)
- Suresh Kumar
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research , Chandigarh , India
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Niinimäki R, Hansen LM, Niinimäki T, Olsen JH, Pokka T, Sankila R, Vettenranta K, Hasle H, Harila-Saari A. Incidence of Severe Osteonecrosis Requiring Total Joint Arthroplasty in Children and Young Adults Treated for Leukemia or Lymphoma: A Nationwide, Register-Based Study in Finland and Denmark. J Adolesc Young Adult Oncol 2013; 2:138-144. [PMID: 24380033 DOI: 10.1089/jayao.2013.0006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The population-based incidence of severe osteonecrosis (ON) necessitating total joint arthroplasty (TJA) in patients with hematological cancer is unknown. This study assessed the incidence of ON requiring primary TJA in children and young adults treated for leukemia or lymphoma. Methods: Patients diagnosed with leukemia or lymphoma before 31 years of age were identified from the Finnish and Danish Cancer Registries. These data were combined with those from the National Hospital Discharge and the Finnish Arthroplasty Registers. Data on the orthopedic procedures performed and the appropriate diagnosis codes given before the age of 40 were also retrieved. Results: The estimated cumulative incidence of TJA was 4.5% at 20 years for patients treated for chronic myeloid leukemia, followed by 2.1% for patients treated for acute myeloid leukemia. It was considerably lower in patients with acute lymphoblastic leukemia (ALL; 0.4%). Multivariate analysis revealed that allogeneic stem cell transplantation (allo-SCT) increased the risk of TJA (hazard ratio [HR]=9.4; 95% CI: 5.3-16.9). The risk of TJA was higher in patients diagnosed with cancer at 10-19 and 20-30 years of age than in those diagnosed before the age of 10 (HR=24; 95% CI: 3.1-176 and HR=26; 95% CI: 3.6-192 respectively). Conclusion: The incidence of ON requiring TJA was highest among patients with myeloid leukemias and lowest in patients treated for ALL. Allo-SCT and age ≥10 years at diagnosis were the most important risk factors for ON requiring TJA in hematological malignancies.
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Affiliation(s)
- Riitta Niinimäki
- Department of Pediatrics, Oulu University Hospital , Oulu, Finland
| | | | | | - Jørgen H Olsen
- Danish Cancer Society, Institute of Cancer Epidemiology , Copenhagen, Denmark
| | - Tytti Pokka
- Department of Pediatrics, Oulu University Hospital , Oulu, Finland
| | - Risto Sankila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research , Helsinki, Finland
| | - Kim Vettenranta
- Division of Hematology-Oncology and Stem Cell Transplantation, Department of Pediatrics, Helsinki University Central Hospital , Helsinki, Finland
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital , Aarhus, Denmark
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Lykissas MG, Gelalis ID, Kostas-Agnantis IP, Vozonelos G, Korompilias AV. The role of hypercoagulability in the development of osteonecrosis of the femoral head. Orthop Rev (Pavia) 2012; 4:e17. [PMID: 22802985 PMCID: PMC3395986 DOI: 10.4081/or.2012.e17] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 04/30/2012] [Indexed: 01/10/2023] Open
Abstract
Despite the large number of the outstanding researches, pathogenesis of osteonecrosis remains unknown. During the last decades the hypothesis that increased intravascular coagulation may be the pathogenetic mechanism which leads to osteonecrosis is gaining constantly support. Both primary factors of hyper-coagulability, such as resistance to activated protein C, protein C and protein S deficiency, low levels of tissue plasminogen activator, high levels of plasminogen activator inhibitor, von Willebrand factor, lipoprotein (a), and secondary factors of hypercoagulability with factors potentially activating intravascular coagulation, such as pregnancy, antiphospholipid antibodies, systemic lupus erythematosus, hemoglobinopathies and sickle cell disease, and hemato-oncologic diseases are discussed in this article. Although coagulation abnormalities in patients with hip osteonecrosis might represent increased risk factors for the development of bone necrosis by predisposing the patient to thromboembolic phenomena, further investigation is needed to indicate the definite correlation between factors leading to increased intravascular coagulation and pathogenesis of osteonecrosis.
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Affiliation(s)
- Marios G Lykissas
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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