Assessment of corticosteroid-induced osteonecrosis in children undergoing chemotherapy for acute lymphoblastic leukemia: a report from the Japanese Childhood Cancer and Leukemia Study Group.
Assessment of corticosteroid-induced osteonecrosis in children undergoing chemotherapy for acute lymphoblastic leukemia: a report from the Japanese Childhood Cancer and Leukemia Study Group.
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DOI：
10.1097/mph.0000000000000039
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发表时间：
2014-01
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影响因子：
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通讯作者：
Japanese Childhood Cancer and Leukemia Study Group (JCCLSG)
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作者：
Hyakuna N;Shimomura Y;Watanabe A;Taga T;Kikuta A;Matsushita T;Kogawa K;Kawakami C;Horikoshi Y;Iwai T;Okamoto Y;Tsurusawa M;Asami K;Japanese Childhood Cancer and Leukemia Study Group (JCCLSG)
补充数字内容可在文本中找到。激素性骨坏死（ON）是儿童急性淋巴细胞白血病（ALL）现代化疗过程中遇到的一个具有挑战性的并发症。我们回顾性评估了3项连续日本儿童癌症和白血病研究组ALL研究（ALL 941 [1994 - 2000]，n=464; ALL 2000 [2000 - 2004]，n=305;和ALL 2004 [2004 - 2010]，n=326）中共1095例患者的ON发生率及其风险因素。16例患者被诊断为ON，其中15例有症状。在ALL 941、ALL 2000和ALL 2004中，ON的累积发生率分别为0.76%、0.35%和3.6%。ALL 941/2000组仅使用泼尼松龙作为激素，ON发生率明显低于ALL 2004组使用地塞米松作为部分替代泼尼松龙（P<0.01）。在ALL 2004中，性别和年龄与ON的发病率显著相关（男孩1.3% vs.女孩6.7%，P=0.0132;年龄<10岁为0.42% vs.年龄≥ 10岁为15.6%，P<0.0001），表明10岁及以上的女孩发生ON的风险更大。这些结果表明，在10岁及以上的女孩中，将地塞米松作为ALL方案治疗的一部分时，应考虑ON的风险。
Supplemental Digital Content is available in the text. Steroid-induced osteonecrosis (ON) is a challenging complication encountered during modern chemotherapy for childhood acute lymphoblastic leukemia (ALL). We retrospectively assessed the incidence of ON and its risk factors in a total of 1095 patients enrolled in 3 consecutive Japanese Children’s Cancer and Leukemia Study Group ALL studies (ALL941 [1994 to 2000], n=464; ALL2000 [2000 to 2004], n=305; and ALL2004 [2004 to 2010], n=326). ON was diagnosed in 16 patients, of whom 15 were symptomatic. The cumulative incidence of ON was 0.76% in ALL941, 0.35% in ALL2000, and 3.6% in ALL2004. The incidence of ON in ALL941/2000, in which only prednisolone was administered as a steroid, was significantly lower than that in ALL2004, in which dexamethasone was used as a partial substitute for prednisolone (P<0.01). In ALL2004, sex and age were significantly correlated with the incidence of ON (1.3% in boys vs. 6.7% in girls, P=0.0132; 0.42% for age <10 y vs. 15.6% for age ≥10 y, P<0.0001), suggesting that girls aged 10 years and above are at a greater risk of ON onset. These results indicate that the risk of ON should be considered when administering dexamethasone as part of ALL protocol treatment in girls aged 10 years and above.