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Osteonecrosis in Children Treated for Lymphoma or Solid Tumors

Niinimäki, Riitta A. MD*; Harila-Saari, Arja H. MD, PhD*; Jartti, Airi E. MD, PhD; Seuri, Raija M. MD; Riikonen, Pekka V. MD, PhD§; Pääkkö, Eija L. MD, PhD; Möttönen, Merja I. MD, PhD*; Lanning, Marjatta MD, PhD*

Journal of Pediatric Hematology/Oncology: November 2008 - Volume 30 - Issue 11 - p 798-802
doi: 10.1097/MPH.0b013e31818ab29d
Original Articles

Purpose The purpose of this study was to find out the incidence of and clinical risk factors for magnetic resonance imaging (MRI)-detected osteonecrosis (ON) in children treated for lymphoma or solid tumors.

Patients and Methods The development of ON was studied in 32 childhood cancer patients who underwent MRI scanning of the lower extremities at the end of their treatment. The underlying malignancy was Wilms tumor in 8 patients, non-Hodgkin lymphoma (NHL) in 8, Hodgkin disease (HD) in 7, rhabdomyosarcoma in 6, and other occasional solid tumors in 3 patients.

Results Six of the 32 patients (19%) had ON. The mean age of the patients with ON at diagnosis was 12.7 years compared with 5.8 years for the patients without ON (P<0.001). All the patients with ON had either HD (4 patients) or NHL (2 patients). Two (33%) of the patients with ON were symptomatic.

Conclusions ON in MRI was found to be a common complication in children after treatment for HD or NHL. The risk for ON seems to be very low in patients with other solid tumors even when they receive high cumulative doses of dexamethasone.

Departments of *Pediatrics

Radiology, Oulu University Hospital, Oulu

Departments of Radiology

§Pediatrics, Kuopio University Hospital, Kuopio, Finland

Supported by grants from the Nona and Kullervo Väre Foundation, Finland and the Alma and K. A. Snellman Foundation, Oulu, Finland and Cancer Society of Northern Finland.

Reprints: Riitta A. Niinimäki, MD, Department of Pediatrics, Oulu University Hospital, Box 23, 90029 OYS, Finland (e-mail:

Received for publication November 5, 2007; accepted July 29, 2008

© 2008 Lippincott Williams & Wilkins, Inc.