Hahn Seung Min, Lee Myeongjee, Huser Aaron, Gim Yeonji, Kim Eun Hwa, Kim Minsoo, Aldosari Amaal M, Jung Inkyung, Kwak Yoon Hae
Division of Pediatric Hematology & Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Korea.
J Clin Med. 2022 Apr 28;11(9):2489. doi: 10.3390/jcm11092489.
Osteonecrosis (ON) is a serious complication of acute lymphocytic leukaemia (ALL) or lymphoblastic lymphoma (LBL) treatment, and there is little information regarding ON in Korean paediatric and young adult patients. This retrospective cohort study assessed the cumulative incidence of and risk factors for ON using national health insurance claims data from 2008 to 2019 in 4861 ALL/LBL patients. The Kaplan-Meier method was used to estimate the cumulative incidence of ON according to age groups; the Cox proportional hazard regression model was used to identify risk factors related to ON development after diagnosing ALL/LBL. A cause-specific hazard model with time-varying covariates was used to assess the effects of risk factors. Overall, 158 (3.25%) patients were diagnosed with ON, among whom 23 underwent orthopaedic surgeries. Older age, radiotherapy (HR = 2.62, 95% confidence interval (CI) 1.87-3.66), HSCT (HR = 2.40, 95% CI 1.74-3.31), steroid use and anthracycline use (HR = 2.76, CI 1.85-4.14) were related to ON in the univariate analysis. In the multivariate analysis, age and steroid and asparaginase use (HR = 1.99, CI 1.30-3.06) were factors associated with ON. These results suggest that Korean patients with ALL/LBL who used steroids and asparaginase should be closely monitored during follow-up, even among young adult patients.
骨坏死（ON）是急性淋巴细胞白血病（ALL）或淋巴母细胞淋巴瘤（LBL）治疗的严重并发症，而关于韩国儿科和年轻成年患者骨坏死的信息较少。这项回顾性队列研究利用2008年至2019年4861例ALL/LBL患者的国家健康保险理赔数据，评估了骨坏死的累积发病率和危险因素。采用Kaplan-Meier方法根据年龄组估计骨坏死的累积发病率；使用Cox比例风险回归模型识别ALL/LBL诊断后与骨坏死发生相关的危险因素。采用具有时变协变量的特定病因风险模型评估危险因素的影响。总体而言，158例（3.25%）患者被诊断为骨坏死，其中23例接受了骨科手术。单因素分析显示，年龄较大、放疗（风险比[HR]=2.62，95%置信区间[CI]1.87-3.66）、造血干细胞移植（HSCT）（HR=2.40，95%CI 1.74-3.31）、使用类固醇和蒽环类药物（HR=2.76，CI 1.85-4.14）与骨坏死相关。多因素分析显示，年龄以及使用类固醇和天冬酰胺酶（HR=1.99，CI 1.30-3.06）是与骨坏死相关的因素。这些结果表明，使用类固醇和天冬酰胺酶的韩国ALL/LBL患者，即使是年轻成年患者，在随访期间也应密切监测。
