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: CLINICAL FEATURE, XRAY AND MRI IMAGING, AND RISK FACTORS
