背景:骨坏死(ON)是癌症治疗的潜在致残骨骼并发症。尽管有症状的骨坏死(sON)在急性淋巴细胞白血病(ALL)中是众所周知的,发病率约为6%,关于小儿霍奇金淋巴瘤(HL)中sON的研究很少。这项研究的目的是检查发病率,危险因素,以及接受HL治疗的儿童sON的结果。
方法:2005年至2019年期间,瑞典共有490名18岁以下儿童被诊断为HL,芬兰,丹麦有资格参加这项研究。关于患者特征的数据,HL治疗,sON的发展是从患者的医疗记录中收集的。磁共振成像扫描用于建立ON诊断并根据Niinimäki分级系统对ON进行分级。
结果:纳入的489例患者中sON的2年累积发生率为5.5%(n=30)。年龄较大的患者发生sON的风险较高(比值比[OR]1.25,95%置信区间[CI]:1.05-1.49,p<.010),女性(OR4.45,CI1.87-10.58,p<.001),高总累积糖皮质激素(GC)剂量(OR1.76,95%CI:1.21-2.56,p=0.003),和晚期HL(OR2.19,95%CI:1.03-4.65,p=0.042)。4例(13.3%)患者接受了大型外科手术,13例(43.3%)患者在随访时因ON而出现持续症状。
结论:这项研究表明sON在小儿HL和小儿ALL中一样常见,与风险因素,如年龄较大,女性性别,高累积GC剂量,先进的HL。未来HL方案的开发应旨在通过修改GC处理来减轻ON的负担。
BACKGROUND: Osteonecrosis (ON) is a potentially disabling skeletal complication of cancer treatment. Although symptomatic
osteonecrosis (sON) is well-known in acute lymphoblastic leukemia (ALL), with an incidence around 6%, studies on sON in pediatric Hodgkin lymphoma (HL) are scarce. The aim of this
study was to examine the incidence, risk factors, and outcome of sON in children treated for HL.
METHODS: A total of 490 children under 18, diagnosed with HL between 2005 and 2019 in Sweden, Finland, and Denmark were eligible for the
study. Data on patient characteristics, HL treatment, and development of sON were collected from patients\' medical records. Magnetic resonance imaging scans were used to establish ON diagnosis and grade ON according to the Niinimäki grading system.
RESULTS: Cumulative 2-year incidence of sON among the 489 included patients was 5.5% (n = 30). The risk for developing sON was higher for those with older age (odds ratio [OR] 1.25, 95% confidence interval [CI]: 1.05-1.49, p < .010), female sex (OR 4.45, CI 1.87-10.58, p < .001), high total cumulative glucocorticoid (GC) doses (OR 1.76, 95% CI: 1.21-2.56, p = 0.003), and advanced HL (OR 2.19, 95% CI: 1.03-4.65, p = .042). Four (13.3%) patients underwent major surgical procedures and 13 (43.3%) had persistent symptoms due to ON at follow-up.
CONCLUSIONS: This
study shows that sON is as common in pediatric HL as in pediatric ALL, with risk factors such as older age, female sex, high cumulative GC doses, and advanced HL. Future HL protocol development should aim to reduce the burden of ON by modifying GC treatment.