title: Effectiveness of pamidronate as treatment of symptomatic osteonecrosis occurring in children treated for acute lymphoblastic leukemia.
abstract: BACKGROUND
  Osteonecrosis (ON) is a severe complication of acute lymphoblastic leukemia (ALL) treatments. Recent studies suggest that bisphosphonates might reduce pain and loss of motor function in patients with ON. We assessed the effects of pamidronate compared to standard care in patients with symptomatic ON (sON) and studied whether steroids might be continued after diagnosis of ON in some patients.
  
  
  METHODS
  We evaluated 17 patients with sON as complication of primary ALL treatment between 2000 and 2008. Fourteen patients were treated with pamidronate. Mobility and pain control were monitored in all patients. Affected joints were classified by magnetic resonance imaging (MRI) at ON diagnosis and after 6-72 months.
  
  
  RESULTS
  Out of 220 patients with ALL, 17 (7.7%) patients developed sON. The median age at ALL diagnosis was 11 years (range: 2.7-16.6 years) and sON occurred a median of 13.4 months (range: 2.5-34 months) after ALL diagnosis. Affected joints were hip, knee and ankle. MRI scans showed 7 severe, 4 moderate, and 6 mild ON lesions. Fourteen patients showed improvement in pain (77% of patients) and motor function (59% of patients), even though corticoids were reintroduced in 4 patients. MRI demonstrated improvement, stability or worsening in 6, 3, and 5 cases, respectively.
  
  
  CONCLUSIONS
  Pamidronate seems to be effective in the management of pain and motor function recovery in sON. Further studies are needed to provide evidence as to whether bisphosphonates can be recommended for the treatment or the prevention of ON in childhood ALL patients.
authors.affiliation: Endocrinology Service and Research Center, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Coralie
authors.initials: C
authors.lastname: Leblicq
authors.forename: Caroline
authors.initials: C
authors.lastname: Laverdière
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Décarie
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Delisle
authors.forename: Marc H
authors.initials: MH
authors.lastname: Isler
authors.forename: Albert
authors.initials: A
authors.lastname: Moghrabi
authors.forename: Gilles
authors.initials: G
authors.lastname: Chabot
authors.forename: Nathalie
authors.initials: N
authors.lastname: Alos
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000188:drug therapy; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007596:Joints / Q000473:pathology; D007719:Knee Joint / Q000473:pathology; D008297:Male; D009043:Motor Activity; D010020:Osteonecrosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000077268:Pamidronate; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate