AVASCULAR NECROSIS OF BONE FOLLOWING INTENSIFIED STEROID-THERAPY FOR ACUTE LYMPHOBLASTIC-LEUKEMIA AND HIGH-GRADE MALIGNANT-LYMPHOMA

Five out of nine adults (55%) with lymphoblastic disease developed sev ere avascular necrosis of bone (AVN) when treated with a Berlin-Frankf urt-Munster (BFM) ALL protocol similar to the current joint MRC-ECOG A LL trial (UKALL XII). The principal purpose of these intensified regim ens is to improve long-term disease-free survival without necessarily increasing toxicity and secondary morbidity. The presentation of all f ive was non-specific bone pain occurring after the re-intensification block of chemotherapy containing high doses of dexamethasone. Three ty pes of diagnostic imaging were performed and magnetic resonance imagin g (MRI) proved superior in demonstrating AVN and showed it at an earli er stage than plain radiographs or isotopic scans. We believe that the dose of corticosteroids was the major factor in the development of AV N. The five men in our series all remain in first remission with a med ian disease-free survival of 3.5 years (range 2-8 years) but with vary ing degrees of disability due to AVN. Clinicians involved in UKALL XII and similar trials should be aware of this debilitating and potential ly crippling complication when using high-dose steroid-containing regi mens, perform MRI scan early and modify treatment if necessary.