Avascular necrosis of bone--a complication of aggressive therapy for acute lymphoblastic leukemia.

The purpose of the present paper was to report cases of avascular necrosis of bone (AVNB) arising as a complication of chemotherapy for acute lymphoblastic leukemia (ALL). X-rays and 99mtechnicium-MDP bone scans were performed on patients with symptoms of bone pain, whereby five patients out of 850 patients were detected to have avascular necrosis of the femoral head. All had received aggressive chemotherapy with steroids. Two patients were still on therapy for the primary disease. In these patients further chemotherapy was continued without steroids. The median period from diagnosis of ALL to development of AVNB was 29 months. Three patients underwent corrective surgical procedures. To conclude, the data suggest that patients receiving combination chemotherapy, especially those with high cumulative doses, run a risk of developing AVNB. Awareness of this complication is important in order to have an early diagnosis so as to limit disability.

[1]  D. Jones.  Multifocal osteonecrosis following chemotherapy and short-term corticosteroid therapy in a patient with small-cell bronchogenic carcinoma. , 1994, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[2]  H. Mankin,et al.  Nontraumatic necrosis of bone (osteonecrosis). , 1992, The New England journal of medicine.

[3]  L. Sleeper,et al.  Sickle cell disease as a cause of osteonecrosis of the femoral head. , 1991, The New England journal of medicine.

[4]  P. Ell,et al.  Bone imaging and skeletal radiology in dysbaric osteonecrosis. , 1987, Clinical radiology.

[5]  H. Oda,et al.  Vitamin D3 metabolism in idiopathic osteonecrosis of femoral head. , 1987, Nihon Seikeigeka Gakkai zasshi.

[6]  S. Advani,et al.  Avascular necrosis following combination chemotherapy. , 1985, Indian Journal of Cancer.

[7]  A. Barquet.  A vascular necrosis following traumatic hip dislocation in childhood: factors of influence. , 1982, Acta orthopaedica Scandinavica.

[8]  R. Alison,et al.  Avascular necrosis of bone complicating treatment of malignant lymphoma. , 1981, The American journal of medicine.

[9]  W. M. Park,et al.  Osteonecrosis in Hodgkin's disease. , 1978, The British journal of radiology.

[10]  Gj Wang,et al.  Fat-cell changes as a mechanism of avascular necrosis of the femoral head in cortisone-treated rabbits. , 1977, The Journal of bone and joint surgery. American volume.

[11]  R. Cruess,et al.  The etiology of steroid-induced avascular necrosis of bone. A laboratory and clinical study. , 1975, Clinical orthopaedics and related research.

[12]  E. Engleman,et al.  Osseous avascular necrosis associated with systemic abnormalities. , 1966, Arthritis and rheumatism.

[13]  A. Mazabraud,et al.  Idiopathic necrosis of the femoral head in adults. , 1965, The Journal of bone and joint surgery. British volume.

[14]  H. R. Mccarroll,et al.  DIAGNOSIS AND TREATMENT OF CONGENITAL SUBLUXATION (DYSPLASIA) AND DISLOCATION OF THE HIP IN INFANCY. , 1965, The Journal of bone and joint surgery. American volume.

[15]  C. Forkner,et al.  The skeletal lesions of acute leukemia , 1961, Cancer.

[16]  C. Pui,et al.  Avascular femoral head necrosis in pediatric cancer patients. , 1993, Medical and pediatric oncology.

[17]  C. Han,et al.  Avascular Necrosis of the Femoral Head in Adult , 1991 .

[18]  S. Pai,et al.  Avascular Necrosis of Bone in Acute Lymphoblastic Leukemia , 1987, The American journal of pediatric hematology/oncology.