Department of Pediatrics, Oulu University Hospital, Oulu, Finland.
Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland.
Br J Haematol. 2024 Oct;205(4):1460-1468. doi: 10.1111/bjh.19687. Epub 2024 Aug 3.
Osteonecrosis (ON) is a common complication of glucocorticoid-based Hodgkin lymphoma (HL) treatment, but the natural evolution and prognosis of ON lesions remain poorly understood. We describe the radiological evolution of ON lesions identified in a Nordic population-based cohort of paediatric HL patients. Magnetic resonance images of suspected ON lesions were centrally reviewed to confirm ON diagnosis and grade the ON lesions according to the Niinimäki classification. The study included 202 ON lesions in 46 patients, of which 77 were joint lesions. Follow-up images were available for 146/202 lesions, with a mean follow-up time of 28 months. During follow-up, 71% of the lesions remained stable, 26% improved or resolved, and 3% progressed. A higher ON grade at diagnosis was associated with a lower likelihood of spontaneous resolution. The likelihood for resolution of ON decreased by 50% for each year of added patient age, when adjusted for sex, ON location, and symptoms. Hip ON showed less spontaneous improvement compared with other joints, and the risk for surgery was 13-fold in hip ON. Grades 3-4 joint ON has the potential to either progress or resolve, warranting follow-up in patients with severe symptoms. Research on secondary prevention should be directed at grade 3-4 joint ON.
骨坏死（ON）是糖皮质激素为基础的霍奇金淋巴瘤（HL）治疗的常见并发症，但 ON 病变的自然演变和预后仍知之甚少。我们描述了在北欧人群为基础的儿科 HL 患者队列中发现的 ON 病变的放射学演变。疑似 ON 病变的磁共振图像由中心进行审查，以确认 ON 诊断，并根据 Niinimäki 分类对 ON 病变进行分级。该研究包括 46 名患者中的 202 个 ON 病变，其中 77 个为关节病变。146/202 个病变有随访图像，平均随访时间为 28 个月。在随访期间，71%的病变保持稳定，26%的病变改善或消退，3%的病变进展。诊断时的 ON 分级越高，自发消退的可能性越低。当调整性别、ON 位置和症状后，每增加一年患者年龄，ON 消退的可能性就会降低 50%。髋关节 ON 与其他关节相比，自发性改善较少，髋关节 ON 的手术风险是 13 倍。关节 3-4 级 ON 有进展或消退的可能性，因此需要对有严重症状的患者进行随访。二级预防的研究应针对关节 3-4 级 ON。
