Aricò Maurizio, Boccalatte Marie France Pinta, Silvestri Daniela, Barisone Elena, Messina Chiara, Chiesa Robert, Santoro Nicola, Tamaro Paolo, Lippi Alma, Gallisai Domenico, Basso Giuseppe, De Rossi Giulio
OncoEmatologia Pediatrica, Ospedale dei Bambini G. Di Cristina, via Benedettini 1, 90134 Palermo, Italy.
Haematologica. 2003 Jul;88(7):747-53.
Osteonecrosis (ON) is a potentially disabling complication of combination chemotherapy including high doses of steroids. The incidence and main risk factors for symptomatic ON have been investigated in a large group of children treated with high-dose steroids, prednisone and dexamethasone for childhood acute lymphoblastic leukemia (ALL).
From May 1995 to December 1999, 1421 patients <18 years old, with newly diagnosed non-B ALL, were registered in the AIEOP-ALL 95 study. Their data were reviewed to identify patients who developed symptomatic ON. For those who were positively identified additional data were requested concerning ON-related symptoms, treatment and outcome.
Overall, 15 of the 1421 patients developed symptomatic ON (1.1%) in a total of 29 sites. The estimated 5-year cumulative risk for clinically diagnosed ON was 1.6% (SE 0.4). The incidence was significantly higher among females (p=0.01) and older patients, with a peak rate of 7.4% (2.3) among those aged 10 to 17 years (p<0.0001). When the two factors, i.e. age and gender were combined, there was a striking increase in the risk among female patients aged 10 to 17 years. The median time between the diagnosis of ALL and that of ON was 17 months (range 8-45). The hip was the most frequently involved (19/29) site.
Symptomatic ON occurred in only 1.1% of patients treated with BFM-type, intensive chemotherapy for childhood ALL. Female adolescents appear to be the subset of patients with the highest risk of ON, especially when categorized as having high risk leukemia and thus administered higher cumulative doses of dexamethasone.
骨坏死（ON）是包括高剂量类固醇在内的联合化疗可能导致的致残性并发症。在一大群接受高剂量类固醇（泼尼松和地塞米松）治疗儿童急性淋巴细胞白血病（ALL）的儿童中，对有症状骨坏死的发病率和主要危险因素进行了调查。
1995年5月至1999年12月，1421名18岁以下新诊断为非B型ALL的患者被纳入AIEOP-ALL 95研究。对他们的数据进行回顾，以确定出现有症状骨坏死的患者。对于确诊的患者，要求提供有关骨坏死相关症状、治疗和结局的额外数据。
总体而言，1421名患者中有15名（1.1%）在总共29个部位出现有症状骨坏死。临床诊断骨坏死的估计5年累积风险为1.6%（标准误0.4）。女性（p=0.01）和年龄较大的患者发病率显著更高，10至17岁患者的发病率峰值为7.4%（2.3）（p<0.0001）。当年龄和性别这两个因素结合时，10至17岁女性患者的风险显著增加。ALL诊断与骨坏死诊断之间的中位时间为17个月（范围8-45个月）。髋部是最常受累的部位（19/29）。
在接受BFM型强化化疗治疗儿童ALL的患者中，有症状骨坏死仅发生在1.1%的患者中。女性青少年似乎是骨坏死风险最高的患者亚组，尤其是那些被归类为高危白血病并因此接受更高累积剂量地塞米松治疗的患者。
