Endocrine Abstracts

Background: Children receiving chemotherapy for ALL may be susceptible to fractures and avascular necrosis (AVN).

Aim: To determine the incidence and risk factors for bone-related morbidity in children on ALL chemotherapy.

Patients and methods: The medical records of all (n, 186, male: 122) children presenting with ALL between 1997 and 2007 and treated with ALL97/01or UKALL 2003 at one centre were studied. Bone morbidity was defined as any event of limb pain, joint symptoms or back pain that required radiological examination. Fractures and AVN were defined as those confirmed by imaging.

Results: Bone morbidity was reported in 90 (male: 59) out of the 186 (48%) patients. The median age at diagnosis of the children with and without bone morbidity was 8.3 yrs (10th, 90th; 2.2, 14.3) and 3.9 yrs (1.5, 12), respectively (P<0.0001). Fractures and AVN were documented in 28/186 (15%) (male: 21) and 18/186 (9.6%) (male: 11). The median age of children at fractures was 10.6 yrs (2.2, 13.7 yrs) and at AVN was 14 yrs (10, 18) (P<0.005). In the 28 patients, 45 sites of fractures were identified; 22 (49%) occurred in weight-bearing bones (foot, ankle, tibia, fibula and femurs), 18 (40%) occurred in the upper limbs (hands, ulna, radii and humerii) and the remaining occurred in the axial bones. Fractures and AVN occurred during maintenance therapy at a median of 29 months (9.9, 56.4) and 26 months (10, 49) respectively. 25/28 (89%) fractures and 17/18 (94%) AVNs were associated with dexamethasone therapy.

Conclusion: This retrospective study shows that the occurrence of bone morbidity, fracture and AVN in children treated for ALL may be influenced by age, gender and the nature and duration of therapy. These associations may facilitate the development of effective bone protective intervention.