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Incidence, risk factors, and treatment outcome of symptomatic osteonecrosis in Taiwanese children with acute lymphoblastic leukemia: a retrospective cohort study of 245 patients in a single institution

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Abstract

Osteonecrosis (ON) is a potentially disabling complication encountered in children who receive chemotherapy for acute lymphoblastic leukemia (ALL). Considering the possible effect of ethnic difference on the clinical features of symptomatic ON in pediatric ALL, we retrospectively evaluated 245 children with ALL who were treated at Chang Gung Memorial Hospital, Linkou, between 2002 and 2011. Six (2.4 %) patients developed symptomatic ON in a total of 17 sites during the follow-up period. Diagnosis of ON was confirmed by X-ray in seven, magnetic resonance imaging in two, and bone scan in three patients. The estimated cumulative incidence of symptomatic ON in newly diagnosed ALL was 3.4 % at 8 years. Four patients received ON-directed surgical interventions, including total hip replacement in three and arthroplasty in one. The incidence of ON was significantly higher among girls (P = 0.03), patients >10 years old (P = 2.2 × 10−4), and patients who had received more intensive chemotherapy regimen (P = 0.02). These results indicate that the incidence and risk factors in our institute were similar to those observed in Western countries. Future studies surveying the impact on the quality of life of childhood ALL survivors in Taiwan are warranted.

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Acknowledgments

We thank the patients and their families, and our research faculty and staff for participating. This work was supported by the grants CMRPG4A0042 from Chang Gung Memorial Hospital, Taiwan, the Grants NCS-101-2314-B-182A-049 from the National Science Council, Taiwan, and Grants DOH102-TD-C-111-006 from the Department of Health, Taiwan.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fu-Shin Street Kwei-Shan 333, Taoyuan, Taiwan

    Shih-Hsiang Chen, Tsung-Yen Chang, Tang-Her Jaing, Iou-Jih Hung & Chao-Ping Yang

  2. Department of Orthopedic Surgery, Gung Memorial Hospital, Taoyuan, Taiwan

    Mel S. Lee

  3. Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Chao-Jan Wang

  4. College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Shih-Hsiang Chen, Tsung-Yen Chang, Tang-Her Jaing, Mel S. Lee, Chao-Jan Wang, Iou-Jih Hung & Chao-Ping Yang

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  1. Shih-Hsiang Chen
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Correspondence to Shih-Hsiang Chen.

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Chen, SH., Chang, TY., Jaing, TH. et al. Incidence, risk factors, and treatment outcome of symptomatic osteonecrosis in Taiwanese children with acute lymphoblastic leukemia: a retrospective cohort study of 245 patients in a single institution. Int J Hematol 102, 41–47 (2015). https://doi.org/10.1007/s12185-015-1790-4

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  • DOI: https://doi.org/10.1007/s12185-015-1790-4

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