Bony morbidity in children treated for acute lymphoblastic leukemia
Bony morbidity in children treated for acute lymphoblastic leukemia
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DOI：
10.1200/jco.2001.19.12.3066
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发表时间：
2001-06-15
影响因子：
45.3
通讯作者：
Silverman, LB
中科院分区：
文献类型：
--
作者：
Strauss, AJ;Su, JT;Silverman, LB
目的：皮质类固醇广泛应用于急性淋巴细胞白血病（ALL）的治疗。为了确定ALL患儿皮质类固醇相关骨发病率，我们回顾性评估了两个连续的儿科ALL方案的骨折和骨坏死（ON）发生率。1987年至1995年间，在Dana-Farber癌症研究所和儿童医院，连续176名儿童接受了ALL治疗。1987 ~ 1991年采用激素治疗，1991 ~ 1995年采用地塞米松治疗。中位随访时间为7.6年，176例患者的任何骨发病率的5年累积发生率（CI）+/- SE为30% +/-4%，骨折的5年CI为28% +/- 3%，ON的5年CI为7% +/-2%，通过多变量分析，骨发病率的独立预测因素包括诊断时年龄9至18岁（P <0.01）、男性（P <0.01）和地塞米松治疗（P = 0.01）。地塞米松与骨折风险较高相关（5年CI，36% +/- 5% vs泼尼松20% +/- 4%; P = 0.04），但与ON无关（P = 0.40）。176例患者的5年无事件生存率为79% ± 3%。结论：ALL治疗的儿童骨折和ON的发生率较高。年龄较大的儿童、男孩和接受地塞米松治疗的患者发生骨病变的风险增加。未来的研究应在不影响临床疗效的情况下尽量减少皮质类固醇相关的骨病变。J Clin Oncol 19：3066-3072. (C)2001年，美国临床肿瘤学会。
Purpose: Corticosteroids are widely used in the treatment of acute lymphoblastic leukemia (ALL), To determine the frequency of corticosteroid-associated bony morbidity in children with ALL, we retrospectively evaluated the incidence of fractures and osteonecrosis (ON) on two consecutive pediatric ALL protocols.Patients and Methods: One hundred seventy-six consecutive children were treated for ALL between 1987 and 1995 at the Dana-Farber Cancer Institute and Children's Hospital. Prednisone was used as the corticosteroid during postremission therapy from 1987 to 1991, and dexamethasone was used from 1991 to 1995; Medical records for all patients were reviewed to assess the occurrence of fractures and ON.Results; With a median follow-up of 7.6 years, the 5-year cumulative incidence (CI) +/- SE of any bony morbidity for the 176 patients was 30% +/- 4%, with a 5-year CI of fractures of 28% +/- 3% and of ON of 7% +/- 2%, With multivariate analysis, independent predictors of bony morbidity included age 9 to 18 years at diagnosis (P < .01), male sex (P < .01), and treatment with dexamethasane (P = .01). Dexamethasone was associated with a higher risk of fractures (5-year CI, 36% +/- 5% v 20% +/- 4% with prednisone; P = .04), but not ON (P = .40). The 5-year event-free survival for the 176 patients was 79% +/- 3%.Conclusion: Children treated for ALL had a high incidence of fractures and ON. Older children, boys, and patients receiving dexamethasone were at increased risk for the development of bony morbidity, Future studies should attempt to minimize corticosteroid-associated bony morbidity without compromising clinical efficacy. J Clin Oncol 19:3066-3072. (C) 2001 by American Society of Clinical Oncology.