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Radiation-induced bone abnormalities after bone marrow transplantation for childhood leukemia
B D Fletcher1, D B Crom, R A Krance
1Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN 38101.
Purpose:
To identify bone abnormalities related to total-body irradiation (TBI) in long-term survivors of bone marrow transplantation (BMT) for childhood leukemia.
Materials And Methods:
The authors obtained skeletal surveys of 10 survivors of childhood leukemia, ages 5-27 years, who had undergone BMT 7-9 years previously. Pretransplantation "conditioning" regimens were composed of chemotherapy and TBI in doses of 12 or 14.4 Gy.
Results:
Of the six survivors who received TBI before age 8 years, five had osteochondromas and three had metaphyseal growth abnormalities. One also had slipped femoral capital epiphysis. Findings in the four remaining patients, who received TBI at ages 12-19 years, were less severe and less clearly related to TBI (mild scoliosis in two cases, avascular necrosis of the femoral condyles in one, and a femoral enchondroma in one).
Conclusions:
Skeletal abnormalities, previously recognized as sequelae of local external-beam irradiation in children, may occur in long-term survivors of BMT who have received TBI. Younger patients appear to be at the greatest risk.