title: Osteonecrosis: An emerging complication of intensive chemotherapy for childhood acute lymphoblastic leukemia.
abstract: OBJECTIVE
  Osteonecrosis (ON) is a potentially disabling complication of combination chemotherapy including high doses of steroids. The incidence and main risk factors for symptomatic ON have been investigated in a large group of children treated with high-dose steroids, prednisone and dexamethasone for childhood acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  From May 1995 to December 1999, 1421 patients <18 years old, with newly diagnosed non-B ALL, were registered in the AIEOP-ALL 95 study. Their data were reviewed to identify patients who developed symptomatic ON. For those who were positively identified additional data were requested concerning ON-related symptoms, treatment and outcome.
  
  
  RESULTS
  Overall, 15 of the 1421 patients developed symptomatic ON (1.1%) in a total of 29 sites. The estimated 5-year cumulative risk for clinically diagnosed ON was 1.6% (SE 0.4). The incidence was significantly higher among females (p=0.01) and older patients, with a peak rate of 7.4% (2.3) among those aged 10 to 17 years (p<0.0001). When the two factors, i.e. age and gender were combined, there was a striking increase in the risk among female patients aged 10 to 17 years. The median time between the diagnosis of ALL and that of ON was 17 months (range 8-45). The hip was the most frequently involved (19/29) site.
  
  
  CONCLUSIONS
  Symptomatic ON occurred in only 1.1% of patients treated with BFM-type, intensive chemotherapy for childhood ALL. Female adolescents appear to be the subset of patients with the highest risk of ON, especially when categorized as having high risk leukemia and thus administered higher cumulative doses of dexamethasone.
authors.affiliation: OncoEmatologia Pediatrica, Ospedale dei Bambini G. Di Cristina, via Benedettini 1, 90134 Palermo, Italy. arico@ospedalecivicopa.org
authors.forename: Maurizio
authors.initials: M
authors.lastname: Aricò
authors.forename: Marie France Pinta
authors.initials: MF
authors.lastname: Boccalatte
authors.forename: Daniela
authors.initials: D
authors.lastname: Silvestri
authors.forename: Elena
authors.initials: E
authors.lastname: Barisone
authors.forename: Chiara
authors.initials: C
authors.lastname: Messina
authors.forename: Robert
authors.initials: R
authors.lastname: Chiesa
authors.forename: Nicola
authors.initials: N
authors.lastname: Santoro
authors.forename: Paolo
authors.initials: P
authors.lastname: Tamaro
authors.forename: Alma
authors.initials: A
authors.lastname: Lippi
authors.forename: Domenico
authors.initials: D
authors.lastname: Gallisai
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Basso
authors.forename: Giulio
authors.initials: G
authors.lastname: De Rossi
mesh_terms: D000293:Adolescent; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy*; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003907:Dexamethasone; D011241:Prednisone