Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.
Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Pediatr Blood Cancer. 2020 Aug;67(8):e28336. doi: 10.1002/pbc.28336. Epub 2020 May 30.
Osteonecrosis is a debilitating complication in children and adolescents with acute lymphoblastic leukemia or acute lymphoblastic lymphoma (LLy). An objective screening test to identify patients at risk for symptomatic, extensive joint involvement will help manage osteonecrosis.
We performed a prospective, longitudinal pilot study with whole-joint magnetic resonance imaging (MRI) of shoulders, elbows, hips, knees, ankles, and hindfeet to evaluate the incidence and timing of osteonecrosis involving multiple joints in 15 patients with LLy aged 9-21 years at diagnosis.
Osteonecrosis affecting ≥30% of the epiphysis occurred in eight of 15 patients, with a high prevalence in hips (12 of 26 examined [46%]) and knees (10 of 26 [38%]) post reinduction I and in shoulders (seven of 20 [35%]) post reinduction II. Most osteonecrotic hips and knees with ≥30% epiphyseal involvement became symptomatic and/or underwent surgery (100% and 82%, respectively). All eight patients with ≥30% epiphyseal involvement had multijoint involvement. Seven of these patients had hip or knee osteonecrosis by the end of remission induction, and only these patients developed osteonecrosis that became symptomatic and/or underwent surgery in their hips, knees, shoulders, ankles, and/or feet; all of these joints were associated with epiphyseal abnormalities on post reinduction I imaging.
MRI screening in adolescent patients with LLy revealed osteonecrosis in multiple joints. Initial screening with hip and knee MRI at the end of induction may identify susceptible patients who could benefit from referrals to subspecialties, more extensive follow-up imaging of other joints, and early medical and surgical interventions.
骨坏死是儿童和青少年急性淋巴细胞白血病或急性淋巴细胞淋巴瘤（LLy）的一种致残并发症。客观的筛查试验可以识别出有症状、广泛关节受累风险的患者，有助于管理骨坏死。
我们进行了一项前瞻性、纵向的试点研究，对 15 名 9-21 岁诊断为 LLy 的患者进行了全关节磁共振成像（MRI）检查，以评估多个关节骨坏死的发生率和时间。
8 名 15 名患者中出现了影响≥30%骨骺的骨坏死，髋关节（26 个中 12 个[46%]）和膝关节（26 个中 10 个[38%]）在再诱导 I 后和肩部（20 个中 7 个[35%]）在再诱导 II 后发生率较高。大多数患有≥30%骨骺受累的骨坏死髋关节和膝关节出现症状和/或接受手术（分别为 100%和 82%）。所有 8 名患有≥30%骨骺受累的患者均有多处关节受累。其中 7 名患者在缓解诱导结束时患有髋部或膝部骨坏死，只有这些患者在髋部、膝部、肩部、踝关节和/或足部出现症状和/或接受手术的骨坏死；这些关节在再诱导 I 后成像中均与骨骺异常相关。
在青少年 LLy 患者中进行 MRI 筛查显示出多个关节的骨坏死。在诱导结束时对髋关节和膝关节进行初始 MRI 筛查可能会识别出易患患者，这些患者可能受益于转介至专科、对其他关节进行更广泛的随访成像以及早期的药物和手术干预。
