title: Osteonecrosis develops independently from radiological leukemic infiltration of bone in adolescents with acute lymphoblastic leukemia - first findings of the OPAL trial.
abstract: Osteonecrosis (ON) is a debilitating side effect of anti-leukemic treatment. Thus far, the role of leukemic infiltration (LI) of bone is unclear. The first 30 children aged ≥10 years, who were enrolled in the ongoing OPAL trial and had MRI studies at diagnosis and at 6 months, were analyzed. MRI revealed extensive LIs in 24 (80%) patients. The signal abnormalities changed back to a physiological signal in 29 out of 30 children at 6 months. Of the 24 children with LIs at diagnosis, 3 (12.5%) developed ON ≥ II, whereas 4 (66.7%) patients without LIs subsequently developed ON ≥ II (p = .016). No differences between children initially presenting with/without LIs were observed concerning age, pubertal stage, white blood count, immunophenotype, and clinical presentation. Initial radiological LI of bone and, thus, single MRI at diagnosis cannot identify children at high risk of developing radiological ON at 6 months into treatment.
authors.affiliation: a Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty , Center for Child and Adolescent Health, University of Duesseldorf , Duesseldorf , Germany.
authors.forename: Kathinka
authors.initials: K
authors.lastname: Krull
authors.affiliation: a Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty , Center for Child and Adolescent Health, University of Duesseldorf , Duesseldorf , Germany.
authors.forename: Marina
authors.initials: M
authors.lastname: Kunstreich
authors.affiliation: b Department of Diagnostic and Interventional Radiology, Medical Faculty , University of Duesseldorf , Duesseldorf , Germany.
authors.forename: Janina
authors.initials: J
authors.lastname: Klasen-Sansone
authors.affiliation: a Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty , Center for Child and Adolescent Health, University of Duesseldorf , Duesseldorf , Germany.|c Department of Pathology , NYU School of Medicine , New York , NY , USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kloetgen
authors.affiliation: d Clinic of Pediatric Hematology and Oncology , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Gruener
authors.affiliation: d Clinic of Pediatric Hematology and Oncology , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Escherich
authors.affiliation: e Department of Pediatrics , University Medical Centre Schleswig-Holstein , Kiel , Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bleckmann
authors.affiliation: e Department of Pediatrics , University Medical Centre Schleswig-Holstein , Kiel , Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Moericke
authors.affiliation: e Department of Pediatrics , University Medical Centre Schleswig-Holstein , Kiel , Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schrappe
authors.affiliation: f Department of Pediatrics , Evangelical Hospital , Bielefeld , Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Jorch
authors.affiliation: g Department of Pediatrics and Adolescent Medicine , University Medical Center Ulm , Ulm , Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Steinbach
authors.affiliation: h Department of Pediatrics , University Hospital Rostock , Rostock , Germany.
authors.forename: Carl-Friedrich
authors.initials: CF
authors.lastname: Classen
authors.affiliation: i Department of Pediatric Oncology/Hematology , Children's Hospital Cologne , Cologne , Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Guggemos
authors.affiliation: j Pediatric Hematology and Oncology , Elisabeth-Hospital Oldenburg , Oldenburg , Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kolb
authors.affiliation: b Department of Diagnostic and Interventional Radiology, Medical Faculty , University of Duesseldorf , Duesseldorf , Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Klee
authors.affiliation: a Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty , Center for Child and Adolescent Health, University of Duesseldorf , Duesseldorf , Germany.
authors.forename: Arndt
authors.initials: A
authors.lastname: Borkhardt
authors.affiliation: a Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty , Center for Child and Adolescent Health, University of Duesseldorf , Duesseldorf , Germany.
authors.forename: Michaela
authors.identifier: http://orcid.org/0000-0003-4577-0503
authors.initials: M
authors.lastname: Kuhlen
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D006801:Humans; D017254:Leukemic Infiltration; D008279:Magnetic Resonance Imaging; D010020:Osteonecrosis / Q000139:chemically induced / Q000000981:diagnostic imaging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D000970:Antineoplastic Agents
keywords: ALL; adolescents; leukemic infiltration of bone; osteonecrosis