• Osteonecrosis as a complication of polychemotherapy in children suffering from acute leukemia
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Osteonecrosis as a complication of polychemotherapy in children suffering from acute leukemia

SOVREMENNAYA PEDIATRIYA.2018.8(96):87-91; doi 10.15574/SP.2018.96.87

Makieieva N., Odinets Yu., Poddubnaya I.
Kharkiv National Medical University, Ukraine
Communal non-profit enterprise «Municipal Clinical Children's Hospital No.16» of the Kharkiv City Council, Ukraine

The use of polychemotherapy (PCT) protocols resulted in a significant increase in the survival rate in children suffering from acute lymphoblastic leukemia (ALL), but also gave rise to adverse consequences, among which osteonecrosis, which significantly alters the quality of life of patients, is one of the most common. The results of risk factors' study for osteonecrosis development are controversial. Standards for treatment of this complication are not finally created.

Aim: to attract the attention of hematologists to the early diagnostics of osteonecrosis in children suffering from ALL.

Materials and methods: data of examination and treatment of the children suffering from oncohematological disorders, who developed osteonecrosis during therapy, are given.

Results: when the diagnosis of osteonecrosis has been confirmed using MRI, chondroprotectors and ilomedine were used in therapy, that allowed to induce remission.

Conclusions: Due to asymptomatic course of osteonecrosis in children suffering from oncohematological diseases, as soon as development of this complication on the background of the ongoing polychemotherapy is suspected, MRI must be performed. Therapy focused on preventing the progression of osteonecro sis and functional impairment requires further development.

Key words: osteonecrosis, leukemia,children.


1. Amin NL, Feltbower R, Kinsley S et al. (2017). Osteonecrosis in patients with acute lymphoblastic leukaemia: a national questionnaire study. BMJ Paediatrics Open. 1:1–7. https://doi.org/10.1136/bmjpo-2017-000122; PMid:29637145 PMCid:PMC5862222

2. Amin NL, Kinsey S, Feltbower R et al. (2015). Analysis of Long-Term Outcomes, Management and Prevalence of Osteonecrosis in UKALL 2003: 3.5% of Adolescents and Young Adults over 10 Years of Age with Acute Lymphoblastic Leukaemia Required Hip Replacement. Blood. 126(23): 2083–2083.

3. Girard P, Auquier P, Barlogis V et al. (2013). Symptomatic osteonecrosis in childhood leukemia survivors: prevalence, risk factors and impact on quality of life in adulthood. Haematologica. 98(7): 1089–1097. https://doi.org/10.3324/haematol.2012.081265; PMid:23645686 PMCid:PMC3696613

4. Heneghan MB, Rheingold SR, Li Y. (2016). Treatment of Osteonecrosis in Children and Adolescents with Acute Lymphoblastic Leukemia. Clin Lymphoma Myeloma Leuk. 16(4):223–229. https://doi.org/10.1016/j.clml.2015.12.009; PMid:27021949 PMCid:PMC4812880

5. Kuhlen M, Kunstreich M, Krull K et al. (2017). Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge. Blood advances. 1(14): 981–994.

6. Kunstreich M, Kummer S, Laws H-J et al. (2016). Osteonecrosis in children with acute lymphoblastic leukemia. Haematologica. 101(11): 1295–1305. https://doi.org/10.3324/haematol.2016.147595; PMid:27742768 PMCid:PMC5394877

7. Liu LH, Zhang QY, Sun W, Li ZR, Gao FQ. (2017). Corticosteroid-induced Osteonecrosis of the Femoral Head: Detection, Diagnosis, and Treatment in Earlier Stages. Chin Med J. 130: 2601–2607. https://doi.org/10.4103/0366-6999.217094; PMid:29067959 PMCid:PMC5678261

8. Marenzana M, Arnett TR. (2013). The Key Role of the Blood Supply to Bone. Bone Research. 1: 203–215. https://doi.org/10.4248/BR201303001; PMid:26273504 PMCid:PMC4472103

9. Muller HL, Langer T, Schnabel D. (2015). Growth and bone metabolism after oncological disease in childhood and adolescence. Monatsschr Kinderheilkd.163(2): 135–141.

10. Riccio I, Pota E, Marcarelli M et al. (2016). Osteonecrosis as a complication in pediatric patients with acute lymphoblastic leukemia. La Pediatria Medica E Chirurgica. 38(3): 80–86. https://doi.org/10.4081/pmc.2016.118; PMid:28009137

Article received: Jul 17, 2018. Accepted for publication: Nov 24, 2018.