Osteonecrosis following an Intensified Chemotherapy Including High Dose Corticosteroids in Acute Lymphoblastic Leukemia

Ham, Soon Shik; Lee, Sung Moon; Jeon, In sang

Abstract

PURPOSE
The use of greatly intensified anticancer drugs enhances the long-term survival of patients with childhood acute lymphoblastic leukemia (ALL). However, the intensified chemotherapy regimen commonly results in increased long-term morbidity. Dexamethasone, which is more potent than prednisone for its antileukemic effects, has been suspected to more vigorously provoke osteonecrosis (ON). We performed this study to investigate the prevalence and clinical features of ON in the high-risk ALL patients who were treated with high dose corticosteroids. METHODS: We investigated ON in 18 patients who had completed high-risk ALL chemotherapy (CCG-1882, regimen A). We compared the ALL patients with ON and the ALL patients without ON for the clinical features of ALL and for the factors that are related to the development of ON. In addition, the clinical features of ON were evaluated. RESULTS: For the entire study group, 3 (16.7%) of 18 patients had ON. The average age at the time of diagnosis of ON was 10.3 years compared with 6.0 years average age for the total enrolled patients. Among the three patients, 1 (33.3%) was male and 2 (66.7%) were female. The average time that passed from the initiation of chemotherapy to the diagnosis of ON was 23.7 months. A total of 7 joints were involved, with an average of 2.3 joints per patient diagnosed with ON. The affected joints were 3 (42.9%) hips and 4 (57.1%) ankles. CONCLUSION: The result of this study was similar to the previous reports. ON, which could be prevented and treated by decreasing the corticosteroid dose and with instituting early orthopedic intervention, is relatively commonly seen in the older children who are treated with high dose corticosteroid for ALL. In this regard, to minimize the risk of ON, newer chemotherapy protocols for older children should be administered with a reduced dose of dexamethasone.