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Published on: September 18, 2013
Osteonecrosis in paediatric patients with acute lymphoblastic leukaemia treated on Co-ALL-07-03 trial: a single
M Kuhlen1, A Moldovan2, K Krull1
1Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf.
Insights
Childhood leukemia survivors face a high incidence of osteonecrosis (ON), a serious condition impacting daily life. Age emerged as the primary risk factor, necessitating further research into preventive strategies.
Area of Science:
- Pediatric Oncology
- Orthopedic Complications
Background:
- Osteonecrosis (ON) is a significant complication following childhood anti-leukemic treatment.
- Treatment intensity is a critical determinant of ON development.
Observation:
- A retrospective chart review analyzed 124 children (aged 1-18) treated for leukemia between 2003-2009.
- 22 patients developed osteonecrosis (ON) (ARCO I-IV), with follow-up data collected until March 2013.
Findings:
- The 5-year cumulative incidence of ON (grade I-IV) was 25%.
- Older age at Acute Lymphoblastic Leukemia (ALL) diagnosis was the sole independent risk factor for ON (p<0.01).
- Most ON cases involved multiple weight-bearing joints, with 77.2% developing ARCO grade III or higher.
Implications:
- The high incidence of ON suggests factors beyond cumulative steroid dose may be involved.
- ON poses long-term sequelae impacting daily living, requiring risk-adapted diagnostic and preventive strategies.
Background:
Osteonecroses (ON) are a serious problem after anti-leukaemic treatment in childhood and critically depend on treatment intensity. We analysed ON incidence, risk factors and outcome in patients (pts) from our institution treated according to the CoALL 07-03 trial.
Methods:
Between 01.09.2003 and 31.12.2009, 124 children aged 1-18 years were treated, 22 pts with ON (ARCO I-IV) were assessed by retrospective chart review. Follow-up data were collected as of March 2013.
Results:
5-year cumulative incidence of ON grade I-IV was 25%. Median age at ALL diagnosis with vs. without ON was 11 years vs. 4.4 years. In logistic multivariate regression analysis, age was the only independent risk factor for ON (p<0.01). 90.9% of the pts with ON presented with ≥2 bilaterally affected joints, most frequent the weight-bearing joints (95.5%). 77.2% developed ON ≥°III acc. to ARCO. 36.4% underwent core decompression, one patient bilateral total hip arthroplasty. As of March 2013, 12 pts still presented with ON-induced symptoms.
Discussion:
Our data suggest an overall high incidence of ON in pts treated according to trial CoALL 07-03. Cumulative steroid dose in trial CoALL 07-03 was small, thus, the high CI might be triggered by other treatment-related and study population based risk factors.
Conclusion:
ON are a serious problem concerning long-term sequelae with major impact on activities of daily living. Further prospective evaluation is urgently needed to develop risk-adapted diagnostic strategies and preventive and interventional approaches for high-risk pts.
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