Osteonecrosis is a well-recognized complication in patients treated with corticosteroids. The incidence of osteonecrosis in children treated for Hodgkin lymphoma is unknown because prospective whole-body magnetic resonance imaging (MRI) studies are lacking in this patient population. Paediatric patients with newly diagnosed Hodgkin lymphoma who were treated according to a uniform paediatric Hodgkin protocol were eligible for inclusion in this prospective study. Whole-body MRI was performed in all 24 included patients (mean age 15·1 years, 12 girls) both before treatment and after 2 cycles of chemotherapy, and in 16 patients after completion of chemotherapy. Osteonecrosis was identified in 10 patients (41·7%, 95% confidence interval: 22·0-61·4%), with a total of 56 osteonecrotic sites. Osteonecrosis was detected in 8 patients after 2 cycles of OEPA (vincristine, etoposide, prednisone, doxorubicin), and in 2 additional patients after completion of chemotherapy. Epiphyseal involvement of long bones was seen in 4 of 10 children. None of the patients with osteonecrosis had any signs of bone collapse at the times of scanning. Whole-body MRI demonstrates osteonecrosis to be a common finding occurring during therapy response assessment of paediatric Hodgkin lymphoma. Detection of early epiphyseal osteonecrosis could allow for treatment before bone collapse and joint damage may occur.

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Keywords Late effects, Osteonecrosis, Paediatric Hodgkin Lymphoma, Whole-body MRI
Persistent URL dx.doi.org/10.1111/bjh.14452, hdl.handle.net/1765/96505
Journal British Journal of Haematology
Littooij, A.S, Kwee, T.C. (Thomas C.), Enríquez, G. (Goya), Verbeke, J.I.M.L, Granata, C. (Claudio), Beishuizen, A, … Nievelstein, R.A.J. (Rutger A. J.). (2016). Whole-body MRI reveals high incidence of osteonecrosis in children treated for Hodgkin lymphoma. British Journal of Haematology. doi:10.1111/bjh.14452