Osteonecrosis as a complication of treating acute lymphoblastic leukemia in children: A report from the children's cancer group
Osteonecrosis as a complication of treating acute lymphoblastic leukemia in children: A report from the children's cancer group
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DOI：
10.1200/jco.2000.18.18.3262
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发表时间：
2000-09-15
影响因子：
45.3
通讯作者：
Nachman, JB
中科院分区：
文献类型：
--
作者：
Mattano, LA;Sather, HN;Nachman, JB
目的：探讨儿童急性淋巴细胞性白血病(ALL)多疗程、长程激素强化化疗后骨坏死(ON)的发生率、危险因素及发病率。方法：对1409例1~20岁接受CCG-1882方案高危ALL治疗的儿童进行回顾性调查。年龄较大的儿童发病率较高(大于或等于10岁：14.2%+/-1.3%；10岁：0.9%+/-0.4%；P<；0.0001)，尤其是10-15岁的女性和16-20岁的男性(分别为19.2%+/-2.3%和20.7%+/-4.7%)。在10至20岁的患者中，女性的ON发生率高于男性(分别为17.4%+/-2.1%vs11.7%+/-1.6%；P=0.03)，以及随机接受两个21天地塞米松疗程的患者与接受一个疗程的患者(分别为23.2%+/-4.8%vs16.4%+/-4.3%；P=.27)。在各民族中，白人的发病率最高，黑人的发病率最低，其他民族居中(分别为16.7%+/-1.4%和3.3%+/-2.3%和6.7%+/-2.2%；P=0.003)。在使用和不使用ON的患者中，无事件生存率没有差别。在开始所有治疗后3年内确诊的湿疹中，除一例外，94%的患者累及承重关节(S)，74%的患者为多灶性。在84%的患者中，疼痛和/或活动不动的症状是慢性的，其中24%的患者曾接受过骨科手术，另有15%的患者考虑未来可能接受手术。结论：接受包括多个疗程的皮质类固醇在内的所有强化治疗的10-20岁儿童，有显著的继续发展的风险。(C)2000年，由美国临床肿瘤学会提供。
Purpose: To determine the incidence, risk factors, and morbidity for osteonecrosis (ON) in children with acute lymphoblastic leukemia (ALL) treated with intensive chemotherapy including multiple, prolonged courses of corticosteroid.Patients and Methods: The occurrence of symptomatic ON was investigated retrospectively in 1,409 children ages 1 to 20 years old receiving therapy for high-risk ALL on Children's Cancer Group (CCG) protocol CCG-1882.Results: ON was diagnosed in 111 patients (9.3% +/- 0.9%, 3-year life-table incidence). The incidence was higher for older children (greater than or equal to 10 years: 14.2% +/- 1.3% v < 10 years: 0.9% +/- 0.4%; P < .0001), especially females 10 to 15 years old and males 16 to 20 years old (19.2% +/- 2.3% and 20.7% +/- 4.7%, respectively). In patients 10 to 20 years old, the incidence of ON was higher for females versus males (17.4% +/- 2.1% v 11.7% +/- 1.6%, respectively; P = .03) and for patients randomized to receive two 21-day dexamethasone courses versus one course (23.2% +/- 4.8% v 16.4% +/- 4.3%, respectively; P = .27). Among ethnic groups, whites herd the highest incidence and blacks the lowest, with other groups intermediate (16.7% +/- 1.4% v 3.3% +/- 2.3% v 6.7% +/- 2.2%, respectively; P = .003). There was no difference in event-free survival in patients with or without ON. ON wets diagnosed within 3 years of starting ALL therapy in all but one patient, involved weight-bearing joint(s) in 94% of patients, and was multifocal in 74% of patients. Symptoms of pain and/or immobility were chronic in 84% of patients, with 24% having undergone an orthopedic procedure and an additional 15% considered candidates far surgery in the future.Conclusion: Children ages 10 to 20 years who receive intensive ALL therapy, including multiple courses of corticosteroid, are at significant risk for developing ON. (C) 2000 by American Society of Clinical Oncology.