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Deprecated: Implicit conversion from float 233.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Clin+Lymphoma+Myeloma+Leuk 2016 ; 16 (4): 223-229.e2 Nephropedia Template TP
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Treatment of Osteonecrosis in Children and Adolescents with Acute Lymphoblastic Leukemia #MMPMID27021949
Heneghan MB; Rheingold SR; Li Y; Seif AE; Huang YS; McLeod L; Wells L; Fisher BT; Aplenc R
Clin Lymphoma Myeloma Leuk 2016[Apr]; 16 (4): 223-229.e2 PMID27021949show ga
Background: Cure rates for acute lymphoblastic leukemia (ALL) have improved, but as therapy has intensified, the burden of osteonecrosis (ON) has increased. Limited data exist regarding surgical interventions for pediatric ALL patients with ON. Materials and Methods: A multi-center cohort of children with newly diagnosed ALL was established with Pediatric Health Information System (PHIS) data from 43 freestanding children's hospitals from 1999-2011. Patients with ON identified by ICD-9 code were followed for up to 5 years after index ALL admission for the presence of ON-associated orthopedic surgical procedures. Results: A cohort of 10,729 ALL patients was assembled, of which 242(2.33%) were identified with an ICD-9 code for ON within 5 years of ALL diagnosis. Fifty-five patients (22.7%) with ON underwent orthopedic surgical intervention aimed at joint preservation (82%) or replacement (18%) with substantial practice variation by hospital in both the rate and type of surgical intervention. The majority of patients had surgical procedures while receiving Maintenance therapy. None of the patients undergoing surgical intervention required ICU-level care within 14 days of surgery, and there was no associated in-hospital mortality. Conclusions: No standard of care exists for treatment of ALL-associated ON. While considerable practice variation exists, surgical intervention appears relatively safe.