Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge by Michaela Kuhlen, Marina Kunstreich, Kathinka Krull,

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Presentation transcript:

Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge by Michaela Kuhlen, Marina Kunstreich, Kathinka Krull, Roland Meisel, and Arndt Borkhardt BloodAdv Volume 1(14):981-994 June 13, 2017 © 2017 by The American Society of Hematology

Exemplary patient from the OPAL trial. Exemplary patient from the OPAL trial. On coronal images of knees, short tau inversion recovery images (top row) show diffuse hyperintense inhomogeneous signals, and T1-weighted images (bottom row) show diffuse hypointense signals revealing extensive leukemic infiltration of bone at diagnosis. At the 6-month follow-up examination, the hyperintense signal in short tau inversion recovery decreased and the hypointense signal in T1 increased toward normal appearance. At 9 months into treatment, MRI shows asymptomatic lesions in the metaphyses, which shows spontaneous regression beginning at 12 months into treatment. Michaela Kuhlen et al. Blood Adv 2017;1:981-994 © 2017 by The American Society of Hematology

Overview of conceivable pharmacological, nonpharmacological, nonsurgical, and surgical (combined with cellular therapies) potential prevention and intervention options in children and adolescents with ALL. (A) The illustrations depict examples according to the association research circulation osseous (ARCO) classification for the hip joints. Overview of conceivable pharmacological, nonpharmacological, nonsurgical, and surgical (combined with cellular therapies) potential prevention and intervention options in children and adolescents with ALL. (A) The illustrations depict examples according to the association research circulation osseous (ARCO) classification for the hip joints. Screening of underlying coagulopathies and hyperlipidemia to prevent progression of early-stage ON and eventual compensation of vitamin D deficiency may be considered. The colored arrows indicate in which treatment phases and ON stages the depicted prevention strategies might be effective. (B) Overview of conceivable preventive pharmacological interventions in children and adolescents with ALL assigned to the different phases of the Berlin Frankfurt Muenster (BFM) therapy backbone and the cytostatic drugs and the treatment-related metabolic side effects. CPM, cyclophosphamide; HR, high risk; MP, mercaptopurine; MTX, methotrexate; NWB, non–weight-bearing; SR, standard risk; TG, thioguanine; THA, total hip arthroplasty. Michaela Kuhlen et al. Blood Adv 2017;1:981-994 © 2017 by The American Society of Hematology