Kuhlen Michaela, Kunstreich Marina, Gökbuget Nicola
Swabian Children's Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg, Germany.
Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany.
Hemasphere. 2021 Mar 9;5(4):e544. doi: 10.1097/HS9.0000000000000544. eCollection 2021 Apr.
Osteonecrosis is a serious complication of antileukemic therapy associated with severe pain and reduced mobility, ultimately leading to joint destruction and significant long-term morbidity. The 5-year cumulative incidence of osteonecrosis ranges from 11% to 20% in adolescents and young adults to 3% to 8% in patients aged 30 years and older. Most symptomatic patients have multiple joints affected, which in turn poses a risk factor for developing severe osteonecrosis. Osteonecrosis has a multifactorial genesis. Treatment-associated risk factors for developing osteonecrosis depend on the therapeutic context including the use of glucocorticosteroids and the simultaneous and/or intensified use of asparaginase (ASP) which may, among others, exert its effect on blood supply to the bone through hypertriglyceridemia, hypercholesterolemia, and hypertension. Allogeneic hematopoietic stem cell transplantation, bloodstream infections, and genetic factors may additionally impact the risk of osteonecrosis. In this article, the authors used the best available evidence in the literature to develop management recommendations for the use in the context of steroid and asparaginase containing regimens. These considerations may be helpful for similar treatment approaches.
骨坏死是抗白血病治疗的一种严重并发症，伴有剧痛和活动能力下降，最终导致关节破坏和严重的长期发病率。青少年和年轻成人骨坏死的5年累积发病率为11%至20%，30岁及以上患者为3%至8%。大多数有症状的患者有多个关节受累，这反过来又构成了发生严重骨坏死的危险因素。骨坏死有多种成因。与治疗相关的骨坏死危险因素取决于治疗背景，包括糖皮质激素的使用以及天冬酰胺酶（ASP）的同时和/或强化使用，ASP可能通过高甘油三酯血症、高胆固醇血症和高血压等对骨血供产生影响。异基因造血干细胞移植、血流感染和遗传因素可能会额外影响骨坏死风险。在本文中，作者利用文献中现有的最佳证据制定了在含类固醇和天冬酰胺酶方案背景下使用的管理建议。这些考量可能有助于类似的治疗方法。
