Hakan SARBAY, Yasemin IŞIK BALCI, Aziz POLAT, Ali KOÇYİĞİT, Murat OTO, Selin GÜLER

Akut Lenfoblastik Lösemi Tedavisi Seyrinde Osteonekrozis Gelişen İki Olgu

Osteonekroz; çocuklarda akut lenfoblastik lösemi tedavisi sırasında veya sonrasında nadir görülen fakat ciddi sorunlara yol açabilen bir komplikasyondur. Yapılan çalışmalarda ALL tedavisi alan çocuklarda semptomatik osteonekroz insidansı %1,6-9,3 olarak bulunmuştur. Yüksek doz steroid tedavisi en önemli risk faktörüdür. Osteonekrozis fizyopatolojisi tam olarak açıklanamamıştır. Kortikosteroidlerin, sinüzoidal venlerdeki tromboembolilere bağlı mekanik tıkanmaya neden oldukları bunun sonucunda kan akımının azalmasıyla birlikte hipoksiye bağlı olarak osteoblast aktivitesinin azalıp, osteoklast aktivitesinin artmasıyla oluştuğu düşünülmektedir. Osteonekroz tanısında manyetik rezonans görüntüleme erken dönemde en duyarlı tanı yöntemidir. Burada ALL tanısıyla takip edilirken idame tedavisi sırasında osteonekroz gelişen 15 ve 14 yaşlarında 2 kız hasta sunulmuştur.

Two Patients who Developed Osteonecrosis during the Treatment of Acute Lymphoblastic Leukemia

Osteonecrosis is a rare and serious complication that can be developed during or after treatment for acute lymphoblastic leukemia (ALL). The incidence of symptomatic osteonecrosis related to ALL treatment is 1.6-9.3%. High-dose steroid therapy is the major risk factor for osteonecrosis. The pathophysiology is unclear. It is thought that osteonecrosis occurs due to steroid use causing thromboembolism in sinusoidal veins leading to hypoxia resulting in decreased osteoblast activity and increased osteoclast activity. Magnetic resonance imaging is the most sensitive diagnostic method in early period. We present two girls, 15 and 14-year-old, in whom osteonecrosis developed during ALL maintenance therapy.

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Strauss AJ, Su JT, Dalton VM, Gelber RD, Sallan SE, Silverman LB. Bonymorbidity in children treated fo racute lymphoblastic leukaemia. J Clin Oncol 2001; 19: 3066-72.
Nathan PC, Wasilewski-Masker K, Janzen LA. Long-term outcomes in survivors of childhood acute lymphoblastic leukemia. Hematol Oncol Clin North Am 2009; 23: 1065-82.
Sala A, Mattano LA, Barr RD. Osteonecrosis in children an adolescents with cancer- An adverse effect of systemic therapy. Eur J Cancer 2007; 43: 683-9.
Wang BG, Sweet DE, Roger SI, Thomson RC. Fatchanges as a mechanism of avasculer necrosis of the femora lhead in cortisone-treatedrabbits. J Bone JointSurg 1977; 59: 729-35.
Murphy RG, Greenberg ML. Osteonecrosis in pediatric patients with acute lymphoblastic leukaemia. Cancer 1990; 65: 1717-21.
Burger B, Beier R, Zimmermann M, Beck JD, Reiter A, Schrappe M. Osteonecrosis: a treatmentrelatedtoxicity in childhood acute lymphoblastic leukemia (ALL)-experiences from trial ALL-BFM 95. Pediatr Blood Cancer 2005; 44: 220-5.
RosenStrauss AJ, Su JT, Dalton VM, Gelber RD, Sallan SE, Silverman LB. Bonymorbidity in children treated for acute lymphoblastic leukemia. J Clin Oncol 2001; 19: 3066-72.
Mattano LA Jr, Sather HN, Trigg ME, Nachman JB. Osteonecrosis as a complication of treating acute lymphoblastic leukaemia in children: a report from the Children's Cancer Group. J Clin Oncol 2000; 18: 3262-72.
Bay A, Öner AF, Etlik Ö, Doğan M. High-dose steroid-related osteonecrosis in a four-year-old child with acute lymphoblastic leukemia. Turk J Haematol 2005; 22: 209-12.