Hui L, Wiernik P H
Albert Einstein Cancer Center, Bronx, NY 10467, USA.
Am J Hematol. 1996 Jul;52(3):184-8. doi: 10.1002/(SICI)1096-8652(199607)52:3<184::AID-AJH8>3.0.CO;2-P.
Four of 55 (7%) adult acute lymphocytic leukemia patients, age 27-58 years, who were treated with methotrexate, vincristine, L-asparaginase, and dexamethasone (MOAD) developed avascular necrosis (AVN) of one or both femoral heads 16-39 months after beginning treatment. All patients were treated with total joint replacement without compromise of quality of life during more than 3-9 years of follow-up, and they have remained in complete remission for a total of 6.5 + to 10.5 + years. A review of the literature revealed 11 previously reported cases of AVN of bone in patients with acute lymphocytic leukemia, 10 of whom received dexamethasone. The patients in the present report received a total dexamethasone dose equivalent to that of prednisone, 3.4-5.0 g/M2. Although AVN of bone has been reported in patients receiving chemotherapy without corticosteroids, corticosteroids appear to be the most common class of agents associated with its development, and dexamethasone treatment may be more likely to result in AVN of bone than other corticosteroids, for unknown reasons.
55例年龄在27 - 58岁的成人急性淋巴细胞白血病患者接受了甲氨蝶呤、长春新碱、L - 天冬酰胺酶和地塞米松（MOAD）治疗，其中4例（7%）在开始治疗后16 - 39个月出现一个或两个股骨头的缺血性坏死（AVN）。所有患者均接受了全关节置换，在超过3 - 9年的随访期间生活质量未受影响，并且他们总共保持完全缓解状态6.5 +至10.5 +年。文献回顾显示，先前有11例急性淋巴细胞白血病患者发生骨AVN的报道，其中10例接受了地塞米松治疗。本报告中的患者接受的地塞米松总剂量相当于泼尼松的剂量，为3.4 - 5.0 g/M²。虽然在接受无皮质类固醇化疗的患者中也有骨AVN的报道，但皮质类固醇似乎是与其发生相关的最常见药物类别，并且地塞米松治疗可能比其他皮质类固醇更易导致骨AVN，原因不明。
