MULTIFOCAL AVASCULAR NECROSIS OF BONES IN CHILDREN AND ADOLESCENTS FOLLOWING POLYCHEMOTHERAPY

Adaequat treatment protocols provide excellent results in management o f lymphoma, leucaemia and other malignancies in children. With improve d survival rates, therapy related sequaela like osteonecrosis (avascul ar necrosis of bone, AVN) have become a matter of increasing concern. From 1982 to 1992 121 patients were treated for acute lymphocytic leuc emia, acute myelocytic leucemia, Hodgkin's Lymphoma, Non-Hodgkin's Lym phoma and Langerhanscell-histiocytosis. All patients were treated with multiagent regimes that included low-dose steroid therapy. 23 patient s died, but 64 patients could be evaluated 4 to 14 years after chemoth erapy. If the patient complained of bone or joint pain or other clinic al findings were suspicious for bony lesions, radiological evaluation was made to get prove of AVN. Six out of 64 patients developed AVN at 17 different sites. Four patients had multifocal AVN. The interval bet ween induction chemotherapy and onset of symptoms was at average 12 mo nths. The average cumulative steroid dosage was 4.25 g. AVN did not re late to sex, diagnosis or a single agent, but did relate to age. There were no cases of AVN in patients younger than 10 years of age. Four p atients required surgical intervention. AVN after polychemotherapy was only seen in patients over the age of 10 years. AVN developed at an a verage of 12 months after induction chemotherapy during the maintenanc e dose phase. Therefore careful clinical monitoring of patients receiv ing polychemotherapy is indicated and if indicated radiological evalua tion for early detection of AVN to prevent further morbidity is necess ary.