Symptomatic osteonecrosis in French survivors of Childhood and
Adolescent Leukemia: a clinical and radiological study from the L.E.A.
program
Abstract
Background. Osteonecrosis (ON) is a long-known complication of acute
leukemia (AL) management affecting 1 to 10% of young patients, leading
to long-term morbidity. Widespread access to Magnetic Resonance Imagery
(MRI) over the past ten years has allowed earlier detection and more
accurate assessment. This study investigated clinical and radiological
features of ON, among the large French cohort L.E.A (Leucémie Enfant
Adolescent) Procedure. Patients with ON were retrospectively enrolled
and risk factors for the onset, the multifocal involvement and severe
damage were analyzed. Quality of life (QoL) was also evaluated. A
sub-study described radiological features. Results. 129/4973 patients
developed ON (2.5%) and were preferentially aged over 10 years at time
of AL diagnosis (OR 22.46, p <10-6). Females were
preferentially affected (OR 1.8, p=0.002) like patients treated for
relapse (OR 1.81, p=0.041). Patients presenting ON suffered more
frequently from other sequelae (p<10-6). Most of the necrosis
were involving weight-bearing joints and multiple joints in 69% of
cases. MRI of 39 patients with ON were double blinded reviewed. Overall,
14/39 suffered from severe impairment, preferentially on hips. QoL of
adolescents and adults was poor and permanently affected once ON
occurred. Conclusions. Age of over 10 years at diagnosis of AL, relapse
and female sex were at risk of developing ON involving preferentially
multiple joints. One third was severe and lasting poor QoL impacting
several domains was found. Future studies should include prospective
data on management and biological genetic features to build a targeted
screening program to detect and manage ON earlier.