High Body Mass Index Increases the Risk for Osteonecrosis in Children With Acute Lymphoblastic Leukemia
| Autor: | Marjatta Lanning, Merja Möttönen, Arja Harila-Saari, Eija Pääkkö, Raija M. Seuri, Airi Jartti, Riitta Niinimäki, Pekka Riikonen |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Adolescent Comorbidity Risk Assessment Severity of Illness Index Dexamethasone Body Mass Index Age Distribution Adrenal Cortex Hormones Predictive Value of Tests Prednisone Internal medicine Acute lymphocytic leukemia Epidemiology Prevalence medicine Humans Prospective Studies Sex Distribution Risk factor Child Finland Probability Analysis of Variance Acute leukemia Dose-Response Relationship Drug medicine.diagnostic_test business.industry Incidence (epidemiology) Osteonecrosis Infant Magnetic resonance imaging Precursor Cell Lymphoblastic Leukemia-Lymphoma medicine.disease Magnetic Resonance Imaging Surgery Causality Logistic Models Oncology Child Preschool Female business Body mass index Follow-Up Studies medicine.drug |
| Zdroj: | Journal of Clinical Oncology. 25:1498-1504 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.2006.06.2539 |
| Popis: | Purpose The aim of the study was to determine the incidence of and clinical risk factors for radiographic osteonecrosis (ON) in children treated for acute lymphoblastic leukemia (ALL) using the Nordic ALL protocols. Patients and Methods Ninety-seven consecutive patients with childhood ALL were studied prospectively by magnetic resonance imaging (MRI) of the lower extremities at the end of the treatment. Results Twenty-three (24%) of the 97 patients had ON. Seven of the patients (30%) were symptomatic, and three patients (13%) required surgical interventions. Multiple logistic regression analysis showed that high body mass index (BMI; P = .04), female sex (P = .01), older age at diagnosis (P < .001), and higher cumulative dexamethasone dose (P = .03) were independent risk factors for radiographic ON. The cumulative prednisone dose did not differ significantly between the patients with and without ON. The incidence of radiographic ON decreased significantly, from 36% to 7%, when the duration of dexamethasone exposure during the delayed-intensification phase was shortened from 3 to 4 weeks to 2 weeks with a taper (P = .001). Conclusion ON as determined by MRI was found to be a common complication in children and adolescents after treatment with the Nordic ALL protocols. Revision of the ALL protocols by shortening the single exposure to dexamethasone has diminished the risk for ON remarkably. High BMI was identified as a new significant risk factor for ON. |
| Databáze: | OpenAIRE |
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