ASEPTIC OSTEONECROSIS IN CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

Joint destruction caused by aseptic osteonecroses (AONs) is a severe c omplication in acute lymphoblastic leukemia (ALL). Here, factors were determined that influence the occurrence and clinical course of AON in ALL patients. Clinical data of 121 patients were correlated with the occurrence of AON. Magnetic resonance imaging was performed in patient s with bone pain. Areas of AONs were correlated with the clinical cour se of AON. Ten patients presented with clinical symptoms of AON and 9 of 10 patients were graded as high-risk ALL compared with 46 of 111 pa tients without AON (chi(2), P < .05). In 10 ALL patients 66 AONs were identified by MRI. In some patients up to 14 different AON sites were observed. The courses of AONs varied in individual patients, suggestin g that necrosis-specific factors might be responsible. A size above 90 0 mm(2) was significantly associated with progressive AON(P<.01). The more intensive treatment regimen in high-risk ALL patients might contr ibute to the development of AON. The clinical course of AON, however, is determined by necrosis-specific factors such as a large size. These data could help in developing therapeutic strategies for the preventi on of progressive AON.