Bürger Britta, Beier Rita, Zimmermann Martin, Beck Jörn D, Reiter Alfred, Schrappe Martin
Hannover Medical School, Department of Pediatric Hematology and Oncology, Hannover, Germany.
Pediatr Blood Cancer. 2005 Mar;44(3):220-5. doi: 10.1002/pbc.20244.
Osteonecrosis (ON) as a complication during treatment of acute lymphoblastic leukemia (ALL) has gained rising attention over the past decade. Corticosteroids, representing an essential element of antileukemic therapy, are known to induce ON, which in turn may cause significant morbidity. Due to spontaneous reporting of affected patients with ON, a group-wide evaluation was performed to determine incidence, risk factors, and morbidity for ON.
Patients were identified via spontaneous reporting to the study center and via questionnaire, addressing all 64 participating centers. We retrospectively analyzed 1,951 patients below 18 years of age who were treated according to trial ALL-BFM 95 between 01.01.1996 and 30.06.2000.
Thirty-one patients (14 male, 17 female) affected by ON were identified. The overall 5-year cumulative incidence for ON is 1.8%. The incidence for patients <10 years is 0.2%, whereas for patients >/=10 years it is 8.9% (P = 0.00) and 16.7% (P = 0.003) for patients >/=15 years. The majority (n = 20) showed ON in two or more joints, and the joints most commonly affected were knees (14 patients, 24 affected knees) and hips (11 patients, 20 affected joints). Thirteen out of 31 patients had to undergo surgery in the course of their disease.
Symptomatic ON is a rare event in patients treated with BFM-type chemotherapy with an overall 5-year cumulative incidence of 1.8%. The age group >/=10 years, and particularly adolescents >/=15 years have a significantly higher risk of developing ON.
在过去十年中，作为急性淋巴细胞白血病（ALL）治疗期间的一种并发症，骨坏死（ON）日益受到关注。已知作为抗白血病治疗重要组成部分的皮质类固醇会诱发骨坏死，进而可能导致严重的发病情况。由于对骨坏死患者的自发报告，进行了一项全组评估以确定骨坏死的发病率、危险因素和发病情况。
通过向研究中心的自发报告和问卷调查来确定患者，涉及所有64个参与中心。我们回顾性分析了1996年1月1日至2000年6月30日期间根据ALL - BFM 95试验接受治疗的1951名18岁以下患者。
确定了31名受骨坏死影响的患者（14名男性，17名女性）。骨坏死的总体5年累积发病率为1.8%。年龄<10岁患者的发病率为0.2%，而年龄≥10岁患者的发病率为8.9%（P = 0.00），年龄≥15岁患者的发病率为16.7%（P = 0.003）。大多数患者（n = 20）在两个或更多关节出现骨坏死，最常受影响的关节是膝盖（14名患者，24个受影响膝盖）和髋关节（11名患者，20个受影响关节）。31名患者中有13名在病程中不得不接受手术。
在接受BFM型化疗的患者中，有症状的骨坏死是一种罕见事件，总体5年累积发病率为1.8%。年龄≥10岁的年龄组，尤其是年龄≥15岁的青少年发生骨坏死的风险显著更高。
