RADIATION-INDUCED BONE ABNORMALITIES AFTER BONE-MARROW TRANSPLANTATION FOR CHILDHOOD LEUKEMIA

PURPOSE: To identify bone abnormalities related to total-body irradiat ion (TBI) in long-term survivors of bone marrow transplantation (BMT) for childhood leukemia. MATERIALS AND METHODS: The authors obtained sk eletal surveys of 10 survivors of childhood leukemia, ages 5-27 years, who had undergone BMT 7-9 years previously. Pretransplantation ''cond itioning'' regimens were composed of chemotherapy and TBI in doses of 12 or 14.4 Gy. RESULTS: Of the six survivors who received TBI before a ge 8 years, five had osteochondromas and three had metaphyseal growth abnormalities. One also had slipped femoral capital epiphysis. Finding s in the four remaining patients, who received TBI at ages 12-19 years , were less severe and less clearly related to TBI (mild scoliosis in two cases, avascular necrosis of the femoral condyles in one, and a fe moral enchondroma in one). CONCLUSIONS: Skeletal abnormalities, previo usly recognized as sequelae of local external-beam irradiation in chil dren, may occur in long-term survivors of BMT who have received TBI. Y ounger patients appear to be at the greatest risk.