Avascular Necrosis of Femoral Head in Childhood Acute Lymphoblastic Leukemia.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4544-4544
Author(s):  
JingYan Tang
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Femoral Head ◽  
Mr Imaging ◽  
Avascular Necrosis ◽  
Solid Tumor ◽  
Lymphoblastic Leukemia ◽  
Hip Pain ◽  
Childhood All ◽  
Necrosis Of Femoral Head

Purpose This study was to determine the frequency of avascular necrosis of femoral head(AVNFH), clinical manifestation, following up results and risk factors in children with acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). Method Acute non-lymphoblastic leukemia and solid tumor as the background, to assess AVNFH in ALL and NHL between October 1998 and June 2003. Glucocorticoid was included in ALL and T-NHL therapy, but not in B-NHL and other diseases. The criteria of AVNFH is clinical hip pain and/or limp with avascular necrosis sign at MR imaging of the femoral head, but no sign of cancer relapse in clinical and laboratory checking. Results We treated ALL 164 cases, T-NHL 28, B-NHL 20, and solid tumor 126 between October 1998 and June 2003. Forty-three patients with ALL and T-NHL are older than 10 years, including 29 boys and 14 girls. Five cases were diagnosed as AVNFH through MR imaging, including 3 with ALL and 2 with T-NHL. No AVNFH happened in B-NHL and other groups. All of AVNFH are older than 14, average 15 years, and presented with hip pain and/or limping after 1 year glucocorticorid contained chemotherapy. It is 2.6%(5/192) in all ALL and T-NHL cases, but 11.6%(5/43) in the group of older than 10 years. Of those 5 patients, 4 girls and 1 boy. So in the group of older than 10 years girls with ALL and T-NHL, AVNFH happened as high as 28.5%(4/14). After medical interfering, 3 recovered, 2 remained slightly limping but no surgical replacement. Conclusion AVNFH incidence in childhood ALL and T-NHL under our therapy protocol is at least 2.6%. Girls, old than 10, with glucocorticoid contained chemotherapy, are the risk factors of AVNFH. Early detection and interfering may make most of them recover. So, regular MR imaging of the hips for girls who are older than 10 years with glucocorticoid contained chemotherapy longer than 1 year, is reasonable if financially tolerated. Clinical data of AVNFH in childhood ALL and T-NHL No sex disease chemo-time AVNFH predinision* status of cancer status of AVNFH * or equile to predinision 45mg/m2.d 1 F LR-ALL 42 months left 150 days CR stable, limp 2 M HR-ALL 12 months right 65 days CR stable, limp 3 F T-NHL 17 months right 90 days CR recover 4 F T-NHL 22 months both sides 105 days CR recover 5 F HR-ALL 42 months both sides 150 days CR recover

Avascular Necrosis of Femoral Head: Findings of Contrast-Enhanced MR Imaging

1995 ◽  
Vol 32 (6) ◽  
pp. 953
Author(s):  
Young Min Kim ◽  
Hee Joong Kim ◽  
Heung Sik Kang ◽  
Chu Wan Kim ◽  
Yong Moon Shin
Keyword(s):  
Femoral Head ◽  
Mr Imaging ◽  
Avascular Necrosis ◽  
Contrast Enhanced ◽  
Necrosis Of Femoral Head

scholarly journals Homozygous Deletion of the p16/MTS1 Gene in Pediatric Acute Lymphoblastic Leukemia Is Associated With Unfavorable Clinical Outcome

Blood ◽  
1997 ◽  
Vol 89 (11) ◽  
pp. 4161-4166 ◽  
Author(s):  
Ursula R. Kees ◽  
Paul R. Burton ◽  
Changlong Lü ◽  
David L. Baker
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Clinical Outcome ◽  
Lymphoblastic Leukemia ◽  
Homozygous Deletion ◽  
Cell Phenotype ◽  
P16 Gene ◽  
Childhood All ◽  
Risk Of Death ◽  
Increased Risk

Abstract The p16 gene (MTS1, CDKN2, p16INK4A, CDKI) encoding an inhibitor of cyclin-dependent kinase 4 (cdk4) has been found to be deleted in various types of tumors, including leukemia, and is thought to code for a tumor suppressor gene. Our preliminary findings on eight pediatric patients with acute lymphoblastic leukemia (ALL) suggested that the survival of patients carrying a homozygous p16 gene deletion was significantly inferior to that of those without a deletion. The present study on 48 patients tested the hypothesis that the clinical outcome for pediatric ALL patients is correlated with the presence or absence of the p16 gene. Overall, nine of 48 children (18.3%) carried a homozygous p16 deletion. Such deletions were significantly more common (P = .003) among T-ALL patients (five of eight, 62.5%) than among precursor-B-ALL patients (four of 40, 10.0%). Of nine patients exhibiting p16 deletions, eight (88.9%) were classified as high-risk patients by the recognized prognostic factors of age, white blood cell count, and T-cell phenotype. The 4-year event-free survival in the study population as a whole was 72.7%. Without adjustment for other risk factors (univariate model), the presence of a homozygous p16 deletion was associated with a markedly increased probability of both relapse (P = .0003) and death (P = .002). These findings raise the question of whether the p16 deletion itself confers an increased risk of relapse after adjusting for the known risk factors. In this analysis, the estimated risk multiplier factor for relapse in patients carrying the p16 deletion was 14.0 (P = .0004) and for the risk of death 15.6 (P = .0008). We therefore conclude that the presence of a homozygous p16 deletion may well be an important risk factor for both relapse and death in childhood ALL, and that its prognostic effect is not a consequence of confounding by other factors already known to influence outcome in this disease.

scholarly journals Environmental Risk Factors for Childhood Acute Lymphoblastic Leukemia: An Umbrella Review

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 382
Author(s):  
Felix M. Onyije ◽  
Ann Olsson ◽  
Dan Baaken ◽  
Friederike Erdmann ◽  
Martin Stanulla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Childhood ◽  
Acute Lymphoblastic Leukemia ◽  
Environmental Risk ◽  
Lymphoblastic Leukemia ◽  
Environmental Risk Factors ◽  
Umbrella Review ◽  
Level Of Evidence ◽  
Childhood All ◽  
High Consumption

Leukemia is the most common type of cancer among children and adolescents worldwide. The aim of this umbrella review was (1) to provide a synthesis of the environmental risk factors for the onset of childhood acute lymphoblastic leukemia (ALL) by exposure window, (2) evaluate their strength of evidence and magnitude of risk, and as an example (3) estimate the prevalence in the German population, which determines the relevance at the population level. Relevant systematic reviews and pooled analyses were identified and retrieved through PubMed, Web of Science databases and lists of references. Only two risk factors (low doses of ionizing radiation in early childhood and general pesticide exposure during maternal preconception/pregnancy) were convincingly associated with childhood ALL. Other risk factors including extremely low frequency electromagnetic field (ELF-MF), living in proximity to nuclear facilities, petroleum, benzene, solvent, and domestic paint exposure during early childhood, all showed some level of evidence of association. Maternal consumption of coffee (high consumption/>2 cups/day) and cola (high consumption) during pregnancy, paternal smoking during the pregnancy of the index child, maternal intake of fertility treatment, high birth weight (≥4000 g) and caesarean delivery were also found to have some level of evidence of association. Maternal folic acid and vitamins intake, breastfeeding (≥6 months) and day-care attendance, were inversely associated with childhood ALL with some evidence. The results of this umbrella review should be interpreted with caution; as the evidence stems almost exclusively from case-control studies, where selection and recall bias are potential concerns, and whether the empirically observed association reflect causal relationships remains an open question. Hence, improved exposure assessment methods including accurate and reliable measurement, probing questions and better interview techniques are required to establish causative risk factors of childhood leukemia, which is needed for the ultimate goal of primary prevention.

scholarly journals Genetic Alterations in Childhood Acute Lymphoblastic Leukemia: Interactions with Clinical Features and Treatment Response

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4068
Author(s):  
Shawn H. R. Lee ◽  
Zhenhua Li ◽  
Si Ting Tai ◽  
Bernice L. Z. Oh ◽  
Allen E. J. Yeoh
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Treatment Response ◽  
Lymphoblastic Leukemia ◽  
Genetic Alterations ◽  
Childhood All ◽  
Genetic Subtypes ◽  
Aggressive Cancer ◽  
Genetic Subtype ◽  
Wbc Count

Acute lymphoblastic leukemia (ALL) is the most common cancer among children. This aggressive cancer comprises multiple molecular subtypes, each harboring a distinct constellation of somatic, and to a lesser extent, inherited genetic alterations. With recent advances in genomic analyses such as next-generation sequencing techniques, we can now clearly identify >20 different genetic subtypes in ALL. Clinically, identifying these genetic subtypes will better refine risk stratification and determine the optimal intensity of therapy for each patient. Underpinning each genetic subtype are unique clinical and therapeutic characteristics, such as age and presenting white blood cell (WBC) count. More importantly, within each genetic subtype, there is much less variability in treatment response and survival outcomes compared with current risk factors such as National Cancer Institute (NCI) criteria. We review how this new taxonomy of genetic subtypes in childhood ALL interacts with clinical risk factors used widely, i.e., age, presenting WBC, IKZF1del, treatment response, and outcomes.

Avascular Necrosis of the Femoral Head in Children With Acute Lymphoblastic Leukemia: A 4- to 9-year Follow-up Study

Orthopedics ◽  
2011 ◽  
Author(s):  
Firooz Madadi ◽  
Bibi Shahin Shamsian ◽  
Samin Alavi ◽  
Firoozeh Madadi ◽  
Alireza Eajazi ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Lymphoblastic Leukemia ◽  
Follow Up Study

scholarly journals Role of MRI in the Detection and Monitoring of Lower Limb Osteonecrosis after Chemotherapy in Pediatric Patients with Acute Lymphoblastic Leukaemia

2020 ◽  
pp. 39-48
Author(s):  
Aliaa M. Maarek ◽  
Mohammed M. Dawoud ◽  
Tarek A. Rafat ◽  
Khaled I. Elshafey
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Pediatric Patients ◽  
Lymphoblastic Leukemia ◽  
Lower Limbs ◽  
Joint Involvement ◽  
Mri Findings ◽  
Bone Infarction ◽  
Mri Study

Background: Magnetic resonance imaging (MRI) is the technique that demonstrated the highest sensitivity and specificity in the early diagnosis of osteonecrosis. It allows detecting initial typical signal intensity alterations of the bone marrow when other examinations showed nonspecific findings or even no alterations at all. The aim of this study is to assess the role of magnetic resonance imaging in detection and monitoring osteonecrotic lesions in pediatric patient with acute lymphoblastic leukemia after chemotherapy. Materials and Methods: This prospective study was performed on 30 pediatric patients ranged from 4 to 18 years with acute lymphoblastic leukemia on chemotherapy or after 3months from ending chemotherapy with symptoms suspicious for osteonecrosis (i.e., articular pain). All patients were explained about the procedure to be done. MRI study of whole lower limbs was done for all patients. Results: In the present study all patients were symptomatic. 24\30 patients (80%) had hip pain, 25\30 patients (83.3%) had knee pain and 8\30 patients (26.7%) had limping. We reported that knee pain was the most common complaint representing 83.3% of patients. 11\30 patients (36.7%) had no MRI findings. 19\30 patients (63.3%) had different positive findings; 4 patients (13.3%) had non -articular osteonecrosis (ON) only with no joint involvement (bone infarction), 2 patients (6.7%) had avascular necrosis of femoral head epiphysis without bone infarction and 13 patients (43.3%) had combined bone infarction and avascular necrosis with Joint involvement. Follow up by MRI was done for all patients (30 patients), 27 patients showed no change in MRI findings, one patient progressed from avascular necrosis of the femoral head epiphysis without deformity to avascular necrosis of the femoral head epiphysis with deformity. The other two patient showed regressive course. Conclusion: We concluded that MRI study is mandatory for early detection and monitoring of lower limb osteonecrosis in pediatric patients with acute lymphoblastic leukemia under or after chemotherapy. The radiologist and clinician must do MRI lower limbs routinely and follow up MRI after 4-6 months to first MRI due to some patients had regressive or progressive findings.

Contrast-Enhanced Fat-Suppression MR Imaging of Avascular Necrosis of Femoral Head

2000 ◽  
Vol 42 (2) ◽  
pp. 327
Author(s):  
Tae Kyoung Oh ◽  
Jae Chan Shim ◽  
Ghi Jai Lee ◽  
Jeong Dong Jeon ◽  
Sun Woo Bang ◽  
...  
Keyword(s):  
Femoral Head ◽  
Mr Imaging ◽  
Avascular Necrosis ◽  
Fat Suppression ◽  
Contrast Enhanced ◽  
Necrosis Of Femoral Head

High Body Mass Index Increases the Risk for Osteonecrosis in Children With Acute Lymphoblastic Leukemia

2007 ◽  
Vol 25 (12) ◽  
pp. 1498-1504 ◽  
Author(s):  
Riitta A. Niinimäki ◽  
Arja H. Harila-Saari ◽  
Airi E. Jartti ◽  
Raija M. Seuri ◽  
Pekka V. Riikonen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Acute Lymphoblastic Leukemia ◽  
Body Mass ◽  
Lymphoblastic Leukemia ◽  
Multiple Logistic Regression Analysis ◽  
Significant Risk ◽  
High Body Mass Index ◽  
Childhood All ◽  
High Body

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.

scholarly journals Multivariate Analysis of Femoral Adductor Muscle Contracture after Total Hip Arthroplasty in Patients with Avascular Necrosis of Femoral Head

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Lin Meng ◽  
Dong Zhang ◽  
Qing Wei ◽  
Xinli Zhan ◽  
Jinhong Cai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Adductor Muscle ◽  
Functional Training ◽  
Surgical Methods ◽  
Surgical History ◽  
Necrosis Of Femoral Head

Objective: This study is to investigate the risk factors of femoral head contracture after total hip arthroplasty (THA) in patients with avascular necrosis of femoral head. Methods: Retrospective analysis was performed in 361 cases of femoral head necrosis patients taking THA from September 2016 to December 2017. A total of 179 patients with no significant preoperative adductor muscle contraction were finally enrolled in this study. These 179 patients were further divided into two groups: contracture group (64 cases) and noncompaction group (115 cases). The chi-square test was used to compare the differences between the two groups. Risk factors were identified by logistic regression analysis. Results: Of the patients included, 64 patients (35.75%) developed into end adductor muscle contracture. There were significant differences in limb shortening, surgical history, whether traction, surgical approach, surgical methods, and functional training between the two groups (P<0.05). Logistic regression analysis showed that shortness of extremity, surgical approach, effective traction, surgical history, and etiology were the factors affecting femoral head contracture after THA in patients with avascular necrosis of femoral head. Conclusions: Preoperative traction therapy, surgical methods, and postoperative functional training are the factors that affect the adductor muscle contraction after THA.

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