Hyakuna Nobuyuki, Shimomura Yasuto, Watanabe Arata, Taga Takashi, Kikuta Atsushi, Matsushita Takeji, Kogawa Kazuhiro, Kawakami Chihiro, Horikoshi Yasuo, Iwai Tsuyako, Okamoto Yasuhiro, Tsurusawa Masahito, Asami Keiko
Center of Bone Marrow Transplantation, Hospital of University of the Ryukyus, Okinawa, Japan.
J Pediatr Hematol Oncol. 2014 Jan;36(1):22-9. doi: 10.1097/MPH.0000000000000039.
Steroid-induced osteonecrosis (ON) is a challenging complication encountered during modern chemotherapy for childhood acute lymphoblastic leukemia (ALL). We retrospectively assessed the incidence of ON and its risk factors in a total of 1095 patients enrolled in 3 consecutive Japanese Children's Cancer and Leukemia Study Group ALL studies (ALL941 [1994 to 2000], n=464; ALL2000 [2000 to 2004], n=305; and ALL2004 [2004 to 2010], n=326). ON was diagnosed in 16 patients, of whom 15 were symptomatic. The cumulative incidence of ON was 0.76% in ALL941, 0.35% in ALL2000, and 3.6% in ALL2004. The incidence of ON in ALL941/2000, in which only prednisolone was administered as a steroid, was significantly lower than that in ALL2004, in which dexamethasone was used as a partial substitute for prednisolone (P<0.01). In ALL2004, sex and age were significantly correlated with the incidence of ON (1.3% in boys vs. 6.7% in girls, P=0.0132; 0.42% for age <10 y vs. 15.6% for age ≥10 y, P<0.0001), suggesting that girls aged 10 years and above are at a greater risk of ON onset. These results indicate that the risk of ON should be considered when administering dexamethasone as part of ALL protocol treatment in girls aged 10 years and above.
类固醇诱导的骨坏死（ON）是现代儿童急性淋巴细胞白血病（ALL）化疗过程中遇到的具有挑战性的并发症。我们回顾性评估了连续参加3项日本儿童癌症和白血病研究组ALL研究（ALL941[1994年至2000年]，n = 464；ALL2000[2000年至2004年]，n = 305；ALL2004[2004年至2010年]，n = 326）的总共1095例患者中ON的发生率及其危险因素。16例患者被诊断为ON，其中15例有症状。ALL941中ON的累积发生率为0.76%，ALL2000中为0.35%，ALL2004中为3.6%。在ALL941/2000中仅使用泼尼松龙作为类固醇，其ON发生率显著低于使用地塞米松部分替代泼尼松龙的ALL2004（P<0.01）。在ALL2004中，性别和年龄与ON发生率显著相关（男孩为1.3%，女孩为6.7%，P = 0.0132；年龄<10岁为0.42%，年龄≥10岁为15.6%，P<0.0001），表明10岁及以上女孩发生ON的风险更高。这些结果表明，在10岁及以上女孩的ALL方案治疗中使用地塞米松时应考虑ON的风险。
