Kuhlen Michaela, Kunstreich Marina, Gökbuget Nicola, Escherich Gabriele
Schwäbisches Kinderkrebszentrum, Kinder- und Jugendmedizin, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Universitätskinderklinik, Magdeburg, Deutschland.
Orthopadie (Heidelb). 2022 Oct;51(10):792-799. doi: 10.1007/s00132-022-04301-1. Epub 2022 Sep 7.
Osteonecrosis occurs as an acute and long-term serious side effect in children, adolescents, and adults with acute lymphoblastic leukemia. It is associated with severe pain and reduced mobility, ultimately leading to joint destruction and significant long-term morbidity. The cumulative incidence ranges from 11 to 20% in adolescents and young adults. In symptomatic patients, multiple joints are frequently affected, which in turns poses a risk factor for the development of severe osteonecrosis. The genesis of leukemia-associated osteonecrosis is multifactorial. Risk factors include the use of corticosteroids and asparaginase. These exert their effects on the blood supply to the bone through hypercholesterolemia, hypertriglyceridemia, and hypertension. Bacteriemia, genetic susceptibility, and stem cell transplantation pose additional risk factors. The treatment of osteonecrosis is challenging and not evidence based. Preventive measurements have as yet mainly been tested in preclinical models.
在患有急性淋巴细胞白血病的儿童、青少年和成人中，骨坏死是一种急性且长期的严重副作用。它与严重疼痛和活动能力下降有关，最终会导致关节破坏和严重的长期发病。青少年和年轻成人的累积发病率在11%至20%之间。在有症状的患者中，多个关节经常受到影响，这反过来又成为严重骨坏死发展的一个危险因素。白血病相关骨坏死的发病机制是多因素的。危险因素包括使用皮质类固醇和天冬酰胺酶。这些因素通过高胆固醇血症、高甘油三酯血症和高血压对骨骼的血液供应产生影响。菌血症、遗传易感性和干细胞移植是另外的危险因素。骨坏死的治疗具有挑战性且缺乏循证依据。预防性措施目前主要在临床前模型中进行了测试。
