Background and aims Along with the improved cure rate in paediatric cancer, awareness of treatment related late effects has become increasingly important. Osteonecrosis is an emerging complication of intensive chemotherapy including high doses of steroids. We aimed to describe clinical and imagiologic characteristics of survivors of paediatric hematologic malignancies who developed osteonecrosis.
Material and methods We evaluated 6 patients with osteonecrosis as a complication of leukaemia or lymphoma treatment between September 1998 and September 2013. Osteonecrosis was confirmed by magnetic resonance imaging (MRI) of the symptomatic joints.
Results Of 563 patients, 6 (4 girls, 2 boys) (1,1%) developed symptomatic osteonecrosis, in a total of 11 joints. The median age at diagnosis of malignancy was 14 years (range 10–18 years) and the median interval between primary diagnosis and onset of osteonecrosis related symptoms was 33 months (range 11–120 months). Underlying malignancies were acute lymphoblastic leukaemia (n = 3) and Hodgkin Lymphoma (n = 3). Affected joints were hip (n = 7), knee (n = 3) and elbow (n = 1). All patients had received previous corticosteroid therapy at a median dose in prednisone equivalent of 4239 mg/m2 (range 3918–4600 mg/m2). Treatment of osteonecrosis included restriction of weight-bearing, physiotherapy and analgesics. One patient had to undergo arthrotomy. All patients showed improvement in pain and motor function.
Conclusions In our cohort, there has been a predominance of female adolescents. Weight-bearing joints were the most commonly affected. Increased awareness for skeletal symptoms during follow-up of patients with hematologic malignancies allows early detection of osteonecrosis, leading to prompt intervention and may prevent more severe morbidity.