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Osteonecrosis following treatment for childhood acute lymphoblastic leukaemia: The Southampton Children's Hospital experience

Osteonecrosis following treatment for childhood acute lymphoblastic leukaemia: The Southampton Children's Hospital experience
Osteonecrosis following treatment for childhood acute lymphoblastic leukaemia: The Southampton Children's Hospital experience
Purpose: To determine the prevalence of osteonecrosis (ON) in children following treatment of acute lymphoblastic leukaemia (ALL), characterise these cases and review treatment methods. Methods: All children diagnosed and treated for ALL between 01 January 2003 and 31 December 2013 at our centre were retrospectively reviewed. Logistic regression was used to investigate risk factors for ON occurrence. Results: Of 235 children treated for ALL, 48/235 (20.4%) children suffered musculoskeletal symptoms necessitating radiological investigation. A total of 13 (5.5%) had MRI-diagnosed ON, with a median diagnosis time of 12 months (interquartile range 10 to 14) following initiation of chemotherapy. ON affected 40 joints in 13 children. The most commonly involved joints were hips (14 joints in eight patients) and knees (12 joints in seven patients). Older age at ALL diagnosis was associated with significantly increased risk of development of ON per year (odds ratio 1.35, 95% confidence interval 1.17 to 1.57, p < 0.001). Eight children underwent at least one surgical intervention. Joint arthroplasty was undertaken in nine joints of four children at a mean age of 18.3 years. All patients who underwent hip arthroplasty had previously received core decompression, with a mean time of 27.8 months (18 to 33) between treatments. Conclusions: ON is a significant complication of ALL treatment. Our results suggest risk stratification for development of ON by age, and targeted monitoring of high-risk joints is possible. ON treatment is varied with little evidence base.
1863-2521
440-447
Rhodes, A.
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Gray, J.
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Harvey, N.
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Davies, J.H.
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Oreffo, R.O.C.
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Reading, I.
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Clarke, N.M.P.
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Aarvold, A.
11dc317f-47fd-4b2c-b0a6-78688c679b5a
Rhodes, A.
c6582f43-4f26-4694-b6ed-dd30de1fecbc
Gray, J.
12d5e17c-97bb-4d6d-8fc4-3914b730ed42
Harvey, N.
ce487fb4-d360-4aac-9d17-9466d6cba145
Davies, J.H.
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Oreffo, R.O.C.
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Reading, I.
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Clarke, N.M.P.
76688c21-d51e-48fa-a84d-deec66baf8ac
Aarvold, A.
11dc317f-47fd-4b2c-b0a6-78688c679b5a

Rhodes, A., Gray, J., Harvey, N., Davies, J.H., Oreffo, R.O.C., Reading, I., Clarke, N.M.P. and Aarvold, A. (2017) Osteonecrosis following treatment for childhood acute lymphoblastic leukaemia: The Southampton Children's Hospital experience. Journal of Children's Orthopaedics, 11 (6), 440-447. (doi:10.1302/1863-2548.11.170142).

Record type: Article

Abstract

Purpose: To determine the prevalence of osteonecrosis (ON) in children following treatment of acute lymphoblastic leukaemia (ALL), characterise these cases and review treatment methods. Methods: All children diagnosed and treated for ALL between 01 January 2003 and 31 December 2013 at our centre were retrospectively reviewed. Logistic regression was used to investigate risk factors for ON occurrence. Results: Of 235 children treated for ALL, 48/235 (20.4%) children suffered musculoskeletal symptoms necessitating radiological investigation. A total of 13 (5.5%) had MRI-diagnosed ON, with a median diagnosis time of 12 months (interquartile range 10 to 14) following initiation of chemotherapy. ON affected 40 joints in 13 children. The most commonly involved joints were hips (14 joints in eight patients) and knees (12 joints in seven patients). Older age at ALL diagnosis was associated with significantly increased risk of development of ON per year (odds ratio 1.35, 95% confidence interval 1.17 to 1.57, p < 0.001). Eight children underwent at least one surgical intervention. Joint arthroplasty was undertaken in nine joints of four children at a mean age of 18.3 years. All patients who underwent hip arthroplasty had previously received core decompression, with a mean time of 27.8 months (18 to 33) between treatments. Conclusions: ON is a significant complication of ALL treatment. Our results suggest risk stratification for development of ON by age, and targeted monitoring of high-risk joints is possible. ON treatment is varied with little evidence base.

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Accepted/In Press date: 18 October 2017
e-pub ahead of print date: 20 November 2017
Published date: December 2017

Identifiers

Local EPrints ID: 417373
URI: http://eprints.soton.ac.uk/id/eprint/417373
ISSN: 1863-2521
PURE UUID: b9725361-bb30-4caf-a530-1a7db0e060bc
ORCID for J. Gray: ORCID iD orcid.org/0000-0002-5652-4722
ORCID for N. Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for R.O.C. Oreffo: ORCID iD orcid.org/0000-0001-5995-6726
ORCID for I. Reading: ORCID iD orcid.org/0000-0002-1457-6532

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Date deposited: 30 Jan 2018 17:30
Last modified: 18 Feb 2021 17:02

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