Table 1.
Overview of MRI screening studies in children and adolescents with ALL
| Treatment protocol and recruitment period | Study cohort and design | ON assessment | No. of pts with ON/ALL | Outcome | Reference |
|---|---|---|---|---|---|
| Dexa-based DCOG-ALL98 protocol not specified | ALL not specified, multiple centers | Symptoms during treatment/within 1 y after treatment discontinuation, NCI CTCAE | 38/574 pts, CI 6.1% after 3 y | Clinical follow-up: 14/35 pts asymptomatic,14/35 pts NCI CTCAE °2, 7/35 pts NCI CTCAE °3, 7/35 pts orthop. interventions; radiological follow-up: 6/24 pts partially/completely resolved, 13/24 pts stable ON, 5/24 pts progressive ON | 5 |
| St. Jude Total Therapy Study X11 06/00-10/07 | ALL not specified, single center | After reind. I and II, at completion of therapy, NCI CTCAE | 69/364 pts, Inc.: °1 35.4%, °2-4 14.6% in first year, any ON 71.8%, °1 53.9%, °2-4 17.6% at end of therapy | 215 pts with ON NCI CTCAE °0 at first MRI: 105/215 maintained °0, 62/215 worsened to °1, 27/215 worsened to °2-4; 141 pts with ON NCI CTCAE °1 at first MRI: 14/141 resolved to °0, 82/141 maintained °1, 34/141 worsened to °2-4, 8 pts with ON NCI CTCAE °2-4 at first MRI, no outcome reported | 17 |
| St. Jude Total Therapy Study XV13 06/00-10/07 | ALL 1-18 y, single center | After reind. I and II, at completion of therapy, lesions affecting >30% of the epiphyseal surface = extensive hip osteonecrosis | 30/374 pts CI after 1 y, 17.1%; CI after 4 y, 21.7%; 19 pts with orthop. interv. |
Extensive FH ON: 6.5% in all pts, 24% in pts >10 y,79% of ON within 1 y after start of therapy, all pts asymptomatic before early screening, 19/30 pts developed symptoms within 0-12 mo after ON dx.; spontaneous resolution in 4/8 hips of children <10 y, in 0/34 hips in children in >10 y; extensive lesions:40/48 joints in children >10 y, 19/40 progression to joint collapse, 0/40 improved | 18 |
| St. Jude Total Therapy XIIIA, NHL XIII12 12/91-08/94 | ALL, advanced-stage NHL <18 y, single center | Earliest MRI 1 y after ALL diagnosis Ficat classification | 17/116 pts, Inc.: 15.5% | 8/17 ON pos. pts MRI after 1y: 7/8 pts stable ON, 1/8 pts resolved ON, 15/17 ON pos. pts alive: 8/15 pts free of symptoms, 6/15 pts (occasional) pain, 1/15 pts hip replacement | 14 |
| Nordic ALL protocols9,10 07/92-12/05 | ALL 1-16 y 2 centers | At the end of therapy No established classification system |
23/97 pts, Inc.: 24% | 3/7 pts FH surgery | 15 |
| Not specified 01/90-12/03 | ALL, NHL, CML, Hodgkin, AML, not specified, retrospective study | Various clinical/research indications, according to Steinberg,84 Hernigou and Lambotte,85 and Sugano et al86 | 80 pts, Inc.: — | 66/80 pts bilateral hip ON, 23/80 pts arthroplasty (of 36 hips); median time between oncologic dx arthroplasty: 3.6 y, ON dx arthroplasty: 1.3 y | 16 |
| Not specified 11/06-03/12 | ALL 3-18 y, not specified | At the end of therapy, while follow-up, no established classification system | 54/73 pts, Inc.: 57.5% at end of therapy, 16.4% at follow-up | Asympt. ON: 0/26 pts no JD; symptomatic ON: 3/47 pts JD at end of therapy, 8/47 pts JD/collapse of joint at follow-up | 19 |
°, degree of severity of the toxicity/disease; add., additional; asympt., asymptomatic; CI, cumulative incidence; CTCAE, Common Terminology Criteria for Adverse Events; Dexa, dexamethasone; dx, diagnosis; examin., examination; exclud., excluded; FH, femoral head; Inc., incidence; incl., included; interv., intervention; JD, joint deformation; NCI, National Cancer Institute; orthop., orthopedic; reind., reinduction; pts, patients; sympt., symptomatic.