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Effectiveness of pamidronate as treatment of symptomatic osteonecrosis occurring in children treated for acute lymphoblastic leukemia

Authors

  • Coralie Leblicq MD,

    1. Endocrinology Service and Research Center, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
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  • Caroline Laverdière MD,

    1. Hematology-Oncology Service, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
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  • Jean-Claude Décarie MD,

    1. Medical Imaging Service, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
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  • Jean-François Delisle BPharm, MSc,

    1. Pharmacy Department, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
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  • Marc H. Isler MD,

    1. Orthopedic Surgery Department, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
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  • Albert Moghrabi MD,

    1. Hematology-Oncology Service, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
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  • Gilles Chabot MD,

    1. Bone Metabolism Service, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
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  • Nathalie Alos MD

    Corresponding author
    1. Endocrinology Service and Research Center, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
    2. Bone Metabolism Service, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
    • Associate Professor, Endocrinology and Bone Metabolism Service, Department of Pediatrics CHU Sainte-Justine, 3175 Chemin de la Côte Sainte-Catherine, Montreal, Quebec, Canada H3T 1C5.
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  • Conflict of interest: Nothing to declare.

Abstract

Background

Osteonecrosis (ON) is a severe complication of acute lymphoblastic leukemia (ALL) treatments. Recent studies suggest that bisphosphonates might reduce pain and loss of motor function in patients with ON. We assessed the effects of pamidronate compared to standard care in patients with symptomatic ON (sON) and studied whether steroids might be continued after diagnosis of ON in some patients.

Methods

We evaluated 17 patients with sON as complication of primary ALL treatment between 2000 and 2008. Fourteen patients were treated with pamidronate. Mobility and pain control were monitored in all patients. Affected joints were classified by magnetic resonance imaging (MRI) at ON diagnosis and after 6–72 months.

Results

Out of 220 patients with ALL, 17 (7.7%) patients developed sON. The median age at ALL diagnosis was 11 years (range: 2.7–16.6 years) and sON occurred a median of 13.4 months (range: 2.5–34 months) after ALL diagnosis. Affected joints were hip, knee and ankle. MRI scans showed 7 severe, 4 moderate, and 6 mild ON lesions. Fourteen patients showed improvement in pain (77% of patients) and motor function (59% of patients), even though corticoids were reintroduced in 4 patients. MRI demonstrated improvement, stability or worsening in 6, 3, and 5 cases, respectively.

Conclusions

Pamidronate seems to be effective in the management of pain and motor function recovery in sON. Further studies are needed to provide evidence as to whether bisphosphonates can be recommended for the treatment or the prevention of ON in childhood ALL patients. Pediatr Blood Cancer 2013; 60: 741–747. © 2012 Wiley Periodicals, Inc.

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