Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan.
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Int J Hematol. 2021 Aug;114(2):271-279. doi: 10.1007/s12185-021-03163-1. Epub 2021 May 18.
Osteonecrosis (ON), a long-term complication of acute lymphoblastic leukemia (ALL) treatment affects patients' quality of life. Although the incidence of any ON, including asymptomatic, was 21.7% among children with ALL in the U.S., the actual incidence and risk factors in Asia remain unknown. For over 11 years, we performed hip magnetic resonance imaging (MRI) screening to detect asymptomatic ON while initiating maintenance chemotherapy in newly diagnosed children with ALL. Overall, 164 of 175 patients underwent hip MRI screening. The incidence of symptomatic or any ON was 3.0% and 11.6%, respectively. Asymptomatic ON in patients < 10 and ≥ 10 years old was 4.0% and 35.9%, respectively (P < 0.001). In multivariate analysis, age ≥ 10 years was the only significant risk factor. Asymptomatic ON with necrosis of > 30% of the epiphyseal surface of the femoral head was detected in four patients (2.4%). All were ≥ 10 years. Three of them progressed to severe symptomatic ON. The incidence of any ON in Asia may be lower than that seen in the only screening study in the U.S. Future studies should clarify factors affecting such regional differences and develop an effective approach to avoid the progression of ON in children with ALL.
骨坏死（ON）是急性淋巴细胞白血病（ALL）治疗的长期并发症，会影响患者的生活质量。尽管在美国，ALL 患儿中包括无症状性在内的任何 ON 的发生率为 21.7%，但亚洲的实际发生率和危险因素仍不清楚。11 年来，我们在开始维持化疗时对新诊断的 ALL 患儿进行髋关节磁共振成像（MRI）筛查，以检测无症状性 ON。共有 175 名患儿中的 164 名接受了髋关节 MRI 筛查。症状性或任何 ON 的发生率分别为 3.0%和 11.6%。<10 岁和≥10 岁的无症状性 ON 发生率分别为 4.0%和 35.9%（P<0.001）。多变量分析显示，年龄≥10 岁是唯一的显著危险因素。4 名患儿（2.4%）检测到股骨头骨骺表面>30%坏死的无症状性 ON。他们均≥10 岁。其中 3 名进展为严重症状性 ON。亚洲的任何 ON 发生率可能低于美国唯一的筛查研究中的发生率。未来的研究应明确影响这种区域性差异的因素，并制定有效的方法来避免 ALL 患儿的 ON 进展。
