Osteonecrosis:: A treatment related toxicity in childhood acute lymphoblastic leukemia (ALL) -: Experiences from trial ALL-BFM 95
Osteonecrosis:: A treatment related toxicity in childhood acute lymphoblastic leukemia (ALL) -: Experiences from trial ALL-BFM 95
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DOI：
10.1002/pbc.20244
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发表时间：
2005-03-01
影响因子：
3.2
通讯作者：
Schrappe, M
中科院分区：
文献类型：
--
作者：
Bürger, B;Beier, R;Schrappe, M
背景骨坏死（ON）作为急性淋巴细胞白血病（ALL）治疗过程中的一种并发症，在过去的十年中受到越来越多的关注。皮质类固醇是抗白血病治疗的重要组成部分，已知其可诱导ON，进而导致显著的发病率。由于自发报告了ON受影响患者，因此进行了全组评价，以确定ON手术的发生率、风险因素和发病率。通过向研究中心自发报告和通过问卷调查（涉及所有64家参与中心）确定患者。我们回顾性分析了1996年1月1日至2000年6月30日期间根据试验ALL-BFM 95接受治疗的1,951例18岁以下患者。结果确定了31例受ON影响的患者（14例男性，17例女性）。ON的总体5年累积发生率为1.8%。<10岁患者的发生率为0.2%，大于或等于10岁患者的发生率为8.9%（P = 0.00），大于或等于15岁患者的发生率为16.7%（P = 0.003）。大多数（n = 20）在两个或多个关节中显示ON，最常见的受累关节为膝关节（14例患者，24个受累膝关节）和髋关节（11例患者，20个受累关节）。31名患者中有13人在患病期间不得不接受手术。结论.在接受BFM型化疗的患者中，症状ON是一种罕见事件，总体5年累积发生率为1.8%。大于或等于10岁的年龄组，特别是大于或等于15岁的青少年，发生ON的风险显著更高。（C）2004 Wiley-Liss，Inc.
Background. Osteonecrosis (ON) as a complication during treatment of acute lymphoblastic leukemia (ALL) has gained rising attention over the past decade. Corti costero ids, representing an essential element of antileukemic therapy, are known to induce ON, which in turn may cause significant morbidity. Due to spontaneous reporting of affected patients with ON, a group-wide evaluation was performed to determine incidence, risk factors, and morbidity for ON. Procedure. Patients were identified via spontaneous reporting to the study center and via questionnaire, addressing all 64 participating centers. We retrospectively analyzed 1,951 patients below 18 years of age who were treated according to trial ALL-BFM 95 between 01.01.1996 and 30.06.2000. Results. Thirty-one patients (14 male, 17 female) affected by ON were identified. The overall 5-year cumulative incidence for ON is 1.8%. The incidence for patients < 10 years is 0.2% whereas for patients greater than or equal to10 years it is 8.9% (P=0.00) and 16.7% (P=0.003) for patients greater than or equal to 15 years. The majority (n=20) showed ON in two or more joints, and the joints most commonly affected were knees (14 patients, 24 affected knees) and hips (11 patients, 20 affected joints). Thirteen out of 31 patients had to undergo surgery in the course of their disease. Conclusions. Symptomatic ON is a rare event in patients treated with BFM-type chemotherapy with an overall 5-year cummulative incidence of 1.8%. The age group greater than or equal to 10 years, and particularly adolescents greater than or equal to 15 years have a significantly higher risk of developing ON. (C) 2004 Wiley-Liss, Inc.