Osteonecrosis as a side effect of treating childhood acute lymphoblastic leukemia

This study aimed to investigate the incidence and risk factors for osteonecrosis in pediatric patients with acute lymphoblastic leukemia in Asia.

This study concluded that the incidence of osteonecrosis is low and the only risk factor is aged 10 years or older in these patients.

Osteonecrosis (ON) occurs when there is a loss of blood to the bone, resulting in death of the bone. Chemotherapy for acute lymphoblastic leukemia (ALL) can result in serious side effects. ON is one of the most serious side effects of treatment of childhood ALL. It can lead to severe pain, limited movement and a lower quality of life.

There was a lack of data about ON in pediatric patients with treated ALL in Asia.

This study involved 1662 pediatric patients who had ALL and received treatment. Information from studies ALL-97 and ALL-02 was analyzed. These patients were newly diagnosed with B-cell or T-cell precursor ALL and received treatment. The ALL-97 group were aged 1-15 and the ALL-02 group were aged 1-18. Both groups received DEX and L-asparaginase as treatment. DEX is a steroid and L-asparaginase is a chemotherapy. 38.2% were treated according to the ALL-97 protocol and 61.8% according to the ALL-02 protocol.

1.44% of all patients involved experienced ON. Of these patients, 50% were treated as per ALL-97 protocol and 50% were treated as per ALL-02 protocol.

95.8% of patients with ON were aged older than 10 years. Being aged 10 years or older was the only significant risk factor for ON. Patients aged 10 years or older who were treated according to the ALL-97 protocol had a five-year cumulative incidence of ON of 7.2%. Patients aged 10 years or older who were treated according to the ALL-02 protocol had a five-year cumulative incidence of ON of 5.9%.

This study concluded that there was a low frequency of ON in these patients. It also concluded that the only risk factor for ON was age (aged 10 years or older).

Consult your physician about the potential side effects of treatments for childhood ALL.