Contributions
Abstract: PB1642
Type: Publication Only
Background
Avascular necrosis (AVN), also called osteonecrosis or aseptic necrosis is a condition that occurs when there is loss of blood to the bone, an interruption to the blood supply causes bone to die. Approximately 90% of the acute lymphoblastic leukemia (ALL) patients in childhood can be cured with current intensive treatment protocols. But the morbidity associated with ALL treatment become more important everyday because of the increase in the number of long-term survivors. Osteonecrosis is one of the most common therapy-related debiliating side effects of ALL treatment. Incidence and risk factors vary between study groups and therapeutic regimens. Age at diagnosis >10 years and glucocorticoid cumulative doses are known as the most significant risk factors.
Aims
We aimed to analyse the clinical features of the ALL patients diagnosed with osteonecrosis in our department.
Methods
Patients diagnosed with ALL and treated with modified St. Jude Total XV protocol in Hacettepe University, Pediatric Hematology Department between 1 January 2008 and 31 December 2015 were analysed and the patients diagnosed with osteonecrosis during ALL treatment were included the study. The clinical features that may be associated with osteonecrosis among these patients were analysed retrospectively .
Results
There were 208 patients diagnosed with ALL. Nineteen of them (9%) were diagnosed with osteonecrosis. Nine of them were girls, 10 were boys. The median age of this 19 patients at the diagnosis was 11 years (2-18y) and 15 patients were >10 years of age at the diagnosis. The immunophenotyping was found to be T cell leukemia for 6 of the patients and CALLA+ B cell ALL for the others. Four of them were low risk patients while 6 patients were standart risk and 9 were high risk patients. According to Modified St. Jude Total XV protocol 7 days of high dose methlprednisolone (HDMP) added to protocol as an initial treatment and we randomized patients at doses of 10 mg/kg/d or 20mg/kg/d HDMP: not exceeding at maximum 1000 mg methylprednisolone. After the end of 7th day of steroid concomittant chemotherapy was given and the doses were tapered gradually to 5mg/kg/d and 10mg/kg/d in each group respectively. By the 3rd week of treatment steroid dose was tapered to 2mg/kg/d in both groups and continued with this dose till the end of 3rd week of induction phase. Six patients were found to start treatment with 20mg/kg/d HDMP while 7 started with 10 mg/kg/d and the other 6 patients could not receive HDMP because they had high WBC levels at the diagnosis.
Conclusion
Osteonecrosis is one of the most important morbidities among ALL survivors. According to our study most of the patients were found to be >10 years age and mostly standart or high risk patients compatible with the literature. More studies are needed to identify the therapy-related or non-therapy-related risk factors and determine which patients are under risk to prevent this sequelae.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, Childhood, Osteonecrosis
Abstract: PB1642
Type: Publication Only
Background
Avascular necrosis (AVN), also called osteonecrosis or aseptic necrosis is a condition that occurs when there is loss of blood to the bone, an interruption to the blood supply causes bone to die. Approximately 90% of the acute lymphoblastic leukemia (ALL) patients in childhood can be cured with current intensive treatment protocols. But the morbidity associated with ALL treatment become more important everyday because of the increase in the number of long-term survivors. Osteonecrosis is one of the most common therapy-related debiliating side effects of ALL treatment. Incidence and risk factors vary between study groups and therapeutic regimens. Age at diagnosis >10 years and glucocorticoid cumulative doses are known as the most significant risk factors.
Aims
We aimed to analyse the clinical features of the ALL patients diagnosed with osteonecrosis in our department.
Methods
Patients diagnosed with ALL and treated with modified St. Jude Total XV protocol in Hacettepe University, Pediatric Hematology Department between 1 January 2008 and 31 December 2015 were analysed and the patients diagnosed with osteonecrosis during ALL treatment were included the study. The clinical features that may be associated with osteonecrosis among these patients were analysed retrospectively .
Results
There were 208 patients diagnosed with ALL. Nineteen of them (9%) were diagnosed with osteonecrosis. Nine of them were girls, 10 were boys. The median age of this 19 patients at the diagnosis was 11 years (2-18y) and 15 patients were >10 years of age at the diagnosis. The immunophenotyping was found to be T cell leukemia for 6 of the patients and CALLA+ B cell ALL for the others. Four of them were low risk patients while 6 patients were standart risk and 9 were high risk patients. According to Modified St. Jude Total XV protocol 7 days of high dose methlprednisolone (HDMP) added to protocol as an initial treatment and we randomized patients at doses of 10 mg/kg/d or 20mg/kg/d HDMP: not exceeding at maximum 1000 mg methylprednisolone. After the end of 7th day of steroid concomittant chemotherapy was given and the doses were tapered gradually to 5mg/kg/d and 10mg/kg/d in each group respectively. By the 3rd week of treatment steroid dose was tapered to 2mg/kg/d in both groups and continued with this dose till the end of 3rd week of induction phase. Six patients were found to start treatment with 20mg/kg/d HDMP while 7 started with 10 mg/kg/d and the other 6 patients could not receive HDMP because they had high WBC levels at the diagnosis.
Conclusion
Osteonecrosis is one of the most important morbidities among ALL survivors. According to our study most of the patients were found to be >10 years age and mostly standart or high risk patients compatible with the literature. More studies are needed to identify the therapy-related or non-therapy-related risk factors and determine which patients are under risk to prevent this sequelae.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, Childhood, Osteonecrosis