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Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma

Leukemia volume 15, pages 891–897 (2001)Cite this article

Abstract

The purpose of this study was to determine the frequency with which magnetic resonance (MR) imaging detects avascular necrosis of the bone (AVNB) in children with acute lymphoblastic leukemia (ALL) or advanced-stage non-Hodgkin lymphoma (NHL) who receive prednisone during remission induction, reinduction, and maintenance chemotherapy; to assess the clinical significance of these findings; and to identify factors predictive of AVNB. We prospectively obtained MR imaging of the hips and knees of 116 children who had completed at least 1 year of treatment for ALL or advanced-stage NHL on identical prednisone-containing regimens between December 1991 and October 1994. MR imaging findings of AVNB were compared with clinical outcomes, and the effect of therapeutic and patient factors on the frequency of AVNB was analyzed. The MR imaging findings of 17 of the 116 participating patients were consistent with AVNB. The most common clinical manifestation was joint pain (11 patients). Only one patient had progressive joint deterioration that necessitated surgical replacement. Only age 10 years or more at the time of the primary diagnosis was significantly associated with the development of AVNB (P = 0.004). MR imaging showed changes consistent with AVNB in approximately 15% of this patient population. However, most patients in this study who had MR imaging signs of AVNB did not experience progressive joint destruction, even with continued prednisone therapy. Therefore, the clinical usefulness of MR imaging as a screening tool for AVNB in this set of patients remains uncertain.

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Acknowledgements

We extend special thanks to Paula Phillips, RHIA, CCRA for management of protocol data and to Sharon Naron for editorial assistance. This work was supported in part by grants P30-CA-21765 and PO1-CA-20180 from the National Institutes of Health, by a Center of Excellence grant from the State of Tennessee, and by the American Lebanese Syrian Associated Charities (ALSAC).

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Authors and Affiliations

  1. Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN, USA

    RC Ribeiro, W Kennedy, JT Sandlund, JE Rubnitz, BI Razzouk & C-H Pui

  2. International Outreach Program, St Jude Children's Research Hospital, Memphis, TN, USA

    RC Ribeiro, JT Sandlund, BI Razzouk & C-H Pui

  3. Department of Department of Pediatrics, University of Tennessee-Memphis, College of Medicine, Memphis, TN, USA

    RC Ribeiro & C-H Pui

  4. Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA

    BD Fletcher & SC Kaste

  5. Department of Biostatistics and Epidemiology, St Jude Children's Research Hospital, Memphis, TN, USA

    PL Harrison

  6. Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA

    MD Neel

  7. Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA

    MV Relling

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  1. RC Ribeiro
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Ribeiro, R., Fletcher, B., Kennedy, W. et al. Magnetic resonance imaging detection of avascular necrosis of the bone in children receiving intensive prednisone therapy for acute lymphoblastic leukemia or non-Hodgkin lymphoma. Leukemia 15, 891–897 (2001). https://doi.org/10.1038/sj.leu.2402139

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