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High body mass index increases the risk for osteonecrosis in children with acute lymphoblastic leukemia.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2007 Apr 20; Vol. 25 (12), pp. 1498-504. - Publication Year :
- 2007
-
Abstract
- Purpose: The aim of the study was to determine the incidence of and clinical risk factors for radiographic osteonecrosis (ON) in children treated for acute lymphoblastic leukemia (ALL) using the Nordic ALL protocols.<br />Patients and Methods: Ninety-seven consecutive patients with childhood ALL were studied prospectively by magnetic resonance imaging (MRI) of the lower extremities at the end of the treatment.<br />Results: Twenty-three (24%) of the 97 patients had ON. Seven of the patients (30%) were symptomatic, and three patients (13%) required surgical interventions. Multiple logistic regression analysis showed that high body mass index (BMI; P = .04), female sex (P = .01), older age at diagnosis (P < .001), and higher cumulative dexamethasone dose (P = .03) were independent risk factors for radiographic ON. The cumulative prednisone dose did not differ significantly between the patients with and without ON. The incidence of radiographic ON decreased significantly, from 36% to 7%, when the duration of dexamethasone exposure during the delayed-intensification phase was shortened from 3 to 4 weeks to 2 weeks with a taper (P = .001).<br />Conclusion: ON as determined by MRI was found to be a common complication in children and adolescents after treatment with the Nordic ALL protocols. Revision of the ALL protocols by shortening the single exposure to dexamethasone has diminished the risk for ON remarkably. High BMI was identified as a new significant risk factor for ON.
- Subjects :
- Adolescent
Adrenal Cortex Hormones therapeutic use
Age Distribution
Analysis of Variance
Causality
Child
Child, Preschool
Comorbidity
Dexamethasone adverse effects
Dexamethasone therapeutic use
Dose-Response Relationship, Drug
Female
Finland epidemiology
Follow-Up Studies
Humans
Infant
Logistic Models
Magnetic Resonance Imaging
Male
Osteonecrosis chemically induced
Osteonecrosis diagnosis
Precursor Cell Lymphoblastic Leukemia-Lymphoma diagnosis
Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy
Predictive Value of Tests
Prednisone adverse effects
Prednisone therapeutic use
Prevalence
Probability
Prospective Studies
Risk Assessment
Severity of Illness Index
Sex Distribution
Adrenal Cortex Hormones adverse effects
Body Mass Index
Osteonecrosis epidemiology
Precursor Cell Lymphoblastic Leukemia-Lymphoma epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 25
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 17442991
- Full Text :
- https://doi.org/10.1200/JCO.2006.06.2539