Prevalence of Osteonecrosis in Survivors of Childhood Acute Lymphoblastic Leukaemia of Indian Ethnicity Treated with BFM Protocol

There is paucity of data from low-middle income countries (LMIC) on osteonecrosis (ON) in survivors of childhood acute lymphoblastic leukaemia (cALL-survivors). We conducted this study to estimate prevalence of ON in cALL-survivors of Indian ethnicity and factors affecting it. This cross-sectional study enrolled cALL-survivors post completion of treatment. ON was estimated using magnetic resonance imaging of hip joint. Demographic, anthropometric, therapy/disease-related and biochemical/endocrine factors affecting calcium homeostasis were studied in two groups: with and without ON. Total of 61 out of enrolled 87 cALL-survivors with median age 118 months (range:84–283) were analysed after median 12 months (range:1–113) post completion of therapy. Two-third of the cohort was male and 41% were pubertal. 5/61 (8.2%) were found to have asymptomatic and non-traumatic ON. Three ON were grade II and two were grade III as per Niinimaki radiological classification. Cumulative doses (CD) of dexamethasone, glucocorticoids (GCs), L-asparginase, anthracycline and low serum vit D levels were associated with ON. Other demographic factors including age at diagnosis > 10 year, disease-related, therapy-related factors including cranial irradiation and biochemical/endocrine factors were not associated with ON. The median CD of dexamethasone (p = 0.004) and GCs (p = 0.008) were significantly high in group with ON. Median CD of methotrexate(p = 0.051), anthracycline(p = 0.058) and serum vit D levels(p = 0.054) along with serum alkaline phosphatase levels(p = 0.06) had a trend towards significance but were not statistically significant in ON group. Prevalence of ON of hip in our cohort of cALL-survivors was 8.2%. Higher CD of GCs appeared to be the most significant risk factor associated with ON in our cohort.