Pediatric Acute Lymphoblastic Leukemia | Risk Factors for Skeletal Complications

 

Skeletal complications:

(1) fracture

(2) osteonecrosis

 

Parameters (Risk factors):

(1) age at diagnosis

(2) gender

(3) therapy

Parameter	Finding	Points
age at diagnosis	0 to 8 years of age	0
	9 to 18 years of age	1
gender	female	0
	male	1
therapy	includes dexamethasone	1
	does not include dexamethasone	0

 

where:

• Dexamethasone has better bioavailability, greater CNS penetration and more antileukemia activity (page 3066).

• Osteopenia appears to underly the increased fracture rate.

• Older children were 2 times more likely to have a bone fracture and 5 times more likely to have osteonecrosis (page 3070).

• Boys may be more likely to have fractures due to sports participation and other activities.

• Gender did not affect the rate of osteonecrosis.

• Patients receiving dexamethasone have 2 times the rate of bone fracture.

• The risk for osteonecrosis is not affected by the type of corticosteroid.

 

total number of risk factors =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 3

• The greater the number of risk factors the greater the risk of bone toxicity.