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Article: The incidence, risk factors, and outcomes of symptomatic avascular necrosis of bone among Chinese pediatric patients with acute lymphoblastic leukemia

TitleThe incidence, risk factors, and outcomes of symptomatic avascular necrosis of bone among Chinese pediatric patients with acute lymphoblastic leukemia
Authors
Keywordschild
incidence
osteonecrosis
precursor cell lymphoblastic leukemia-lymphoma
risk factors
young adult
Issue Date31-Mar-2023
PublisherWiley Open Access
Citation
Cancer Medicine, 2023, v. 12, n. 9, p. 10315-10325 How to Cite?
Abstract

Background

Avascular necrosis (AVN) of bone is a debilitating complication of pediatric patients with acute lymphoblastic leukemia (ALL). While it is extensively studied and reported in Western population, studies focused on Orientals are limited. This study aims to evaluate the incidence, risk factors, and clinical outcomes of AVN among Chinese children with ALL.

Methods

This study is a retrospective, territory-wide population-based cohort study of pediatric patients with ALL enrolled on one of the three consecutive ALL study protocols (ALL-IC-BFM 2002, CCLG-ALL 2008, and CCCG-ALL 2015).

Results

A total of 24 out of 533 pediatric subjects with ALL (4.5%) had symptomatic AVN. Age was the single most important risk factor associated with the development of AVN. Only three patients were below age of 10 at the time of diagnosis of ALL. The incidences of AVN in patients aged above and below 10 years were 18.2% ± 3.6% and 0.8% ± 0.5%, respectively, and were significantly different (p < 0.005). Treatment protocol, immunophenotype, and gender were not predictive of AVN. Among the 24 patients, five required orthopedic interventions in view of progressive and severe disease. For subjects with hip joints involvement, follow-up assessments showed 12 of 22 hip joints had radiological progression over a median duration of 3.63 years. Seventeen of them did not have pain at the latest follow-up and among patients with pain (n = 7), five did not experience any limitation on activities of daily living while two required use of walking aids or wheelchair.

Conclusion

The incidence of symptomatic AVN in Chinese ALL patients was comparable to other studies in Western population. Adolescent age more than 10 years old was recognized to be the most important factor for development of AVN. Significant proportion of patients had radiological progression over time with a small percentage of subjects had daily activities affected.


Persistent Identifierhttp://hdl.handle.net/10722/328967
ISSN
2023 Impact Factor: 2.9
2023 SCImago Journal Rankings: 1.174
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorHoo, CPL-
dc.contributor.authorLeung, AWK-
dc.contributor.authorChan, JPK-
dc.contributor.authorCheung, YT-
dc.contributor.authorCheng, FWT-
dc.contributor.authorChow, TTW-
dc.contributor.authorLam, GKS-
dc.contributor.authorHa, SY-
dc.contributor.authorChiang, AKS-
dc.contributor.authorLi, RCH-
dc.contributor.authorLi, CK -
dc.date.accessioned2023-08-05T07:54:17Z-
dc.date.available2023-08-05T07:54:17Z-
dc.date.issued2023-03-31-
dc.identifier.citationCancer Medicine, 2023, v. 12, n. 9, p. 10315-10325-
dc.identifier.issn2045-7634-
dc.identifier.urihttp://hdl.handle.net/10722/328967-
dc.description.abstract<h3>Background</h3><p>Avascular necrosis (AVN) of bone is a debilitating complication of pediatric patients with acute lymphoblastic leukemia (ALL). While it is extensively studied and reported in Western population, studies focused on Orientals are limited. This study aims to evaluate the incidence, risk factors, and clinical outcomes of AVN among Chinese children with ALL.</p><h3>Methods</h3><p>This study is a retrospective, territory-wide population-based cohort study of pediatric patients with ALL enrolled on one of the three consecutive ALL study protocols (ALL-IC-BFM 2002, CCLG-ALL 2008, and CCCG-ALL 2015).</p><h3>Results</h3><p>A total of 24 out of 533 pediatric subjects with ALL (4.5%) had symptomatic AVN. Age was the single most important risk factor associated with the development of AVN. Only three patients were below age of 10 at the time of diagnosis of ALL. The incidences of AVN in patients aged above and below 10 years were 18.2% ± 3.6% and 0.8% ± 0.5%, respectively, and were significantly different (<em>p</em> < 0.005). Treatment protocol, immunophenotype, and gender were not predictive of AVN. Among the 24 patients, five required orthopedic interventions in view of progressive and severe disease. For subjects with hip joints involvement, follow-up assessments showed 12 of 22 hip joints had radiological progression over a median duration of 3.63 years. Seventeen of them did not have pain at the latest follow-up and among patients with pain (<em>n</em> = 7), five did not experience any limitation on activities of daily living while two required use of walking aids or wheelchair.</p><h3>Conclusion</h3><p>The incidence of symptomatic AVN in Chinese ALL patients was comparable to other studies in Western population. Adolescent age more than 10 years old was recognized to be the most important factor for development of AVN. Significant proportion of patients had radiological progression over time with a small percentage of subjects had daily activities affected.</p>-
dc.languageeng-
dc.publisherWiley Open Access-
dc.relation.ispartofCancer Medicine-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectchild-
dc.subjectincidence-
dc.subjectosteonecrosis-
dc.subjectprecursor cell lymphoblastic leukemia-lymphoma-
dc.subjectrisk factors-
dc.subjectyoung adult-
dc.titleThe incidence, risk factors, and outcomes of symptomatic avascular necrosis of bone among Chinese pediatric patients with acute lymphoblastic leukemia-
dc.typeArticle-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1002/cam4.5762-
dc.identifier.scopuseid_2-s2.0-85151962363-
dc.identifier.volume12-
dc.identifier.issue9-
dc.identifier.spage10315-
dc.identifier.epage10325-
dc.identifier.eissn2045-7634-
dc.identifier.isiWOS:000961359100001-
dc.identifier.issnl2045-7634-

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