Abstract
The incidence of aseptic osteonecroses in the therapy of acute leukaemias in children has been studied. Out of 551 children treated at the Children's Hospital in Münster from 1971 to 1985, 6 developed osteonecrosis, an incidence of 1.09%. Of these children, 5 showed unilateral or bilateral necrosis of the femoral head. The osteonecroses occurred 8–109 months after initiation of the primary therapy or of the relapse treatment. The corticoid doses did not differ from those administered to other leukaemia patients without necrosis. Only 1 patient had received prednisone continuously for 1 year, at a total dose of 20.5 g/m2 of body surface area. Of these 6 children, 4 had been immobilized for several weeks before or during therapy. Two children had presented with pain-related relieving posture of the joints in which subsequently the osteonecrosis developed. Inactivity associated with the cortisone therapy seems to be an important factor in the development of aseptic osteonecroses.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- ALL:
-
acute lymphatic leukaemia
- AML:
-
acute myelogenous leukaemia
- BFM:
-
Berlin-Frankfurt-Münster
- DAL:
-
Deutsche Arbeitsgemeinschaft für Leukämieforschung und- behandlung im Kindesalter
References
Aufdermaur M (1979) Bewegungsapparat. In: Büchner F, Grundmann E (eds) Lehrbuch der Speziellen Anatomie. Urban und Schwarzenberg, München Wien, pp 568–577
Benz G, Brandeis WE, Willich E (1976) Radiological aspects of leukaemia in childhood. Pediatr Radiol 4:201–213
Creutzig U, Ritter J, Riehm H, Langermann HJ, Henze G, Kabisch H, Niethammer D, Jürgens H, Stollmann B, Lasson U, Löffler H, Schellong G (1985) Improved treatment results in childhood acute myelogenous leukemia: a report of the German Cooperative Study AML-BFM-78. Blood 65:298–304
Cruess RL (1977) Cortisone-induced avascular necrosis of the femoral head. J Bone Joint Surg [B] 59:308–317
Engel IA, Straus DJ, Lacher M, Lane J, Smith J (1981) Osteonecrosis in patients with malignant lymphoma: a review of twenty-five cases. Cancer 48:1245–1250
Fischer R, Schaefer HE (1972) Die pathologische Anatomie der Leukosen. In: Eros R, Loo J van de (eds) Leukämie. Springer, Berlin Heidelberg New York
Hely D, Fennell RS, Petty W, Hudson T, Richard GA (1982) Osteonecrosis of the femoral head and condyle in the post transplantation courses of children and adolescents. Int J Pediatr Nephrol 3:297–303
Ihde DC, DeVita VT (1975) Osteonecrosis of the femoral head in patients with lymphoma treated with intermittent combination chemotherapy. Cancer 36:1585–1588
Ishii E, Yoshida N, Miyazaki S (1984) Avascular necrosis of bone in neuroblastoma treated with combination chemotherapy. Eur J Pediatr 143:152–153
Kaufmann U, Lampert F (1977) Necrosis of the caput femoris in complete remission of lymphoblastic leukaemia. Klin Padiatr 189:37–40
Ludwig R, Oppermann HC, Geiger H, Willich E (1978) Unusual skeletal changes in acute lymphoblastic leukemia in children. Monatsschr Kinderheilkd 126:401–404
Mitchell GP (1982) Complications of early treatment of congenital dislocation of the hip. In: Tachdjian MO (ed) Congenital dislocation of the hip. Churchill Livingstone, New York, pp 215–245
Muntean W, Zaunschirm A (1983) Aseptic osteonecrosis in children with leukemia prior to institution of treatment. Eur J Pediatr 140:139–140
Prindull G, Weigel W, Jentsch E, Enderle A, Willert HG (1982) Aseptic osteonecrosis in children treated for acute lymphoblastic leukemia and aplastic anemia. Eur J Pediatr 139:48–51
Prosnitz LR, Lawson JP, Friedlaender GE, Farber LR, Pezzimenti JF (1981) Avascular necrosis of bone in Hodgkins discase patients treated with combined modality therapy. Cancer 47: 2793–2797
Scheer U, Schellong G, Riehm H (1979) Verbesserte Prognose der akuten myeloischen Leukämien bei Kindern nach intensivierter Anfangstherapie. Klin Padiatr 191:104–110
Schellong G, Breu H, Gröbe H, Voß W (1978) Intensivierung der Anfangstherapie nach dem West-Berliner Protokoll bei akuter lymphoblastischer Leukämie: Ergebnisse nach 21/2 Jahren in Münster. Klin Padiatr 190:65–72
Schrappe M, Beck J, Brandeis WE, Feickert HJ, Gadner H, Graf N, Havers W, Henze G, Jobke A, Kornhuber B, Kühl J, Lampert F, Müller-Weihrich St, Niethammer D, Reiter A, Ritter J, Schellong G, Tausch W, Weinel P, Riehm H (1987) Die Behandlung der akuten lymphatischen Leukämie im Kindes- und Jugendalter: Ergebnisse der multizentrischen Therapiestudie ALL-BFM 81. Klin Padiatr 199:133–150
Vaughan JM (1975) The physiology of bone. Clarendon Press, Oxford
Wang G, Sweet DE, Reger SI, Charlottesville V, Thompson RC (1977) Fat-cell changes as a mechanism of avascular necrosis of the femoral head in cortison-treated rabbits. J Bone Joint Surg [A] 59:730–735
Wang G, Moga DB, Richemer WG, Sweet DE, Reger S, Thompson RC (1978) Cortison induced bone changes and its response to lipid clearing agents. Clin Orthop 130:81–86
Zaunschirm A, Muntean W, Kaulfersch W, Kurz R, Ritter G, Schneider G (1983) Imitation of Mb. Perthes through acute lymphoblastic leukemia. Padiatr Padol 18:81–86
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bömelburg, T., von Lengerke, H.J. & Ritter, J. Aseptic osteonecroses in the treatment of childhood acute leukaemias. Eur J Pediatr 149, 20–23 (1989). https://doi.org/10.1007/BF02024327
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02024327