title: Assessment of corticosteroid-induced osteonecrosis in children undergoing chemotherapy for acute lymphoblastic leukemia: a report from the Japanese Childhood Cancer and Leukemia Study Group.
abstract: Steroid-induced osteonecrosis (ON) is a challenging complication encountered during modern chemotherapy for childhood acute lymphoblastic leukemia (ALL). We retrospectively assessed the incidence of ON and its risk factors in a total of 1095 patients enrolled in 3 consecutive Japanese Children's Cancer and Leukemia Study Group ALL studies (ALL941 [1994 to 2000], n=464; ALL2000 [2000 to 2004], n=305; and ALL2004 [2004 to 2010], n=326). ON was diagnosed in 16 patients, of whom 15 were symptomatic. The cumulative incidence of ON was 0.76% in ALL941, 0.35% in ALL2000, and 3.6% in ALL2004. The incidence of ON in ALL941/2000, in which only prednisolone was administered as a steroid, was significantly lower than that in ALL2004, in which dexamethasone was used as a partial substitute for prednisolone (P<0.01). In ALL2004, sex and age were significantly correlated with the incidence of ON (1.3% in boys vs. 6.7% in girls, P=0.0132; 0.42% for age <10 y vs. 15.6% for age ≥10 y, P<0.0001), suggesting that girls aged 10 years and above are at a greater risk of ON onset. These results indicate that the risk of ON should be considered when administering dexamethasone as part of ALL protocol treatment in girls aged 10 years and above.
authors.affiliation: Center of Bone Marrow Transplantation, Hospital of University of the Ryukyus, Okinawa, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hyakuna
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Shimomura
authors.forename: Arata
authors.initials: A
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Taga
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kikuta
authors.forename: Takeji
authors.initials: T
authors.lastname: Matsushita
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kogawa
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kawakami
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Horikoshi
authors.forename: Tsuyako
authors.initials: T
authors.lastname: Iwai
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Masahito
authors.initials: M
authors.lastname: Tsurusawa
authors.forename: Keiko
authors.initials: K
authors.lastname: Asami
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D044466:Asian People; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000453:epidemiology; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D003907:Dexamethasone; D011239:Prednisolone