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Published on: October 17, 2025
Incidence and Risk Factors of Symptomatic Osteonecrosis in Children With Acute Lymphoblastic Leukemia-A
Katharina Arnold1, Leila Ronceray1,2, Martin Benesch3
1Department of Pediatric Hematology and Oncology St. Anna Children's Hospital Medical University of Vienna Vienna Austria.
Background:
Osteonecrosis is a clinically relevant therapy-associated complication in pediatric acute lymphoblastic leukemia (ALL).
Methods:
In a nationwide Austrian cohort of 1127 patients with newly diagnosed ALL treated on AIEOP-BFM-ALL 2000 and 2009 protocols, 73 patients developed symptomatic osteonecrosis.
Results:
The corresponding 5-year cumulative incidence was 7% ± 1%, while competing events such as relapse, death, and secondary malignancies were at 13% ± 1%. Median time to osteonecrosis was 1.64 years. Age at diagnosis was the dominant risk factor: the 5-year incidence was 22% ± 3% in adolescent patients 10-18 versus 2% ± 0% in those 1-9 years-old.
Conclusions:
Age remained the only statistically independent predictor for osteonecrosis in multivariable analysis. Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.
