Avascular Necrosis of Femoral Head in Childhood Acute Lymphoblastic Leukemia.

Purpose This study was to determine the frequency of avascular necrosis of femoral head(AVNFH), clinical manifestation, following up results and risk factors in children with acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). Method Acute non-lymphoblastic leukemia and solid tumor as the background, to assess AVNFH in ALL and NHL between October 1998 and June 2003. Glucocorticoid was included in ALL and T-NHL therapy, but not in B-NHL and other diseases. The criteria of AVNFH is clinical hip pain and/or limp with avascular necrosis sign at MR imaging of the femoral head, but no sign of cancer relapse in clinical and laboratory checking. Results We treated ALL 164 cases, T-NHL 28, B-NHL 20, and solid tumor 126 between October 1998 and June 2003. Forty-three patients with ALL and T-NHL are older than 10 years, including 29 boys and 14 girls. Five cases were diagnosed as AVNFH through MR imaging, including 3 with ALL and 2 with T-NHL. No AVNFH happened in B-NHL and other groups. All of AVNFH are older than 14, average 15 years, and presented with hip pain and/or limping after 1 year glucocorticorid contained chemotherapy. It is 2.6%(5/192) in all ALL and T-NHL cases, but 11.6%(5/43) in the group of older than 10 years. Of those 5 patients, 4 girls and 1 boy. So in the group of older than 10 years girls with ALL and T-NHL, AVNFH happened as high as 28.5%(4/14). After medical interfering, 3 recovered, 2 remained slightly limping but no surgical replacement. Conclusion AVNFH incidence in childhood ALL and T-NHL under our therapy protocol is at least 2.6%. Girls, old than 10, with glucocorticoid contained chemotherapy, are the risk factors of AVNFH. Early detection and interfering may make most of them recover. So, regular MR imaging of the hips for girls who are older than 10 years with glucocorticoid contained chemotherapy longer than 1 year, is reasonable if financially tolerated.