Bony morbidity in children treated for acute lymphoblastic leukemia

Purpose: Corticosteroids are widely used in the treatment of acute lymphobl astic leukemia (ALL), To determine the frequency of corticosteroid-associat ed bony morbidity in children with ALL, we retrospectively evaluated the in cidence of fractures and osteonecrosis (ON) on two consecutive pediatric AL L protocols. Patients and Methods: One hundred seventy-six consecutive children were tre ated for ALL between 1987 and 1995 at the Dana-Farber Cancer Institute and Children's Hospital. Prednisone was used as the corticosteroid during postr emission therapy from 1987 to 1991, and dexamethasone was used from 1991 to 1995; Medical records for all patients were reviewed to assess the occurre nce of fractures and ON. Results; With a median follow-up of 7.6 years, the 5-year cumulative incide nce (CI) +/- SE of any bony morbidity for the 176 patients was 30% +/- 4%, with a 5-year CI of fractures of 28% +/- 3% and of ON of 7% +/- 2%, With mu ltivariate analysis, independent predictors of bony morbidity included age 9 to 18 years at diagnosis (P < .01), male sex (P < .01), and treatment wit h dexamethasane (P = .01). Dexamethasone was associated with a higher risk of fractures (5-year CI, 36% +/- 5% v 20% +/- 4% with prednisone; P = .04), but not ON (P = .40). The 5-year event-free survival for the 176 patients was 79% +/- 3%. Conclusion: Children treated for ALL had a high incidence of fractures and ON. Older children, boys, and patients receiving dexamethasone were at incr eased risk for the development of bony morbidity, Future studies should att empt to minimize corticosteroid-associated bony morbidity without compromis ing clinical efficacy. J Clin Oncol 19:3066-3072. (C) 2001 by American Soci ety of Clinical Oncology.