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Identifier 000447749
Title Οστεονέκρωση ως επιπλοκή θεραπείας της οξείας λεμφοβλαστικής λευχαιμίας και των λεμφωμάτων σε παιδιά ,εφήβους και νεαρούς ενήλικες : 15ετής εμπειρία ενός κέντρου
Alternative Title Osteonecrosis as a complication of treatment for acute lymphoblastic leukemia and lymphomas in children ,adolescents and young adults
Creator Μανδελένη Ευαγγελία
Thesis advisor Στειακάκη, Ευτυχία
Reviewer Ραϊσάκη, Μαρία
Δημητρίου, Ροζαλία
Abstract Introduction As the number of cancer survivors diagnosed with Acute Lymphoblastic Leukemia (ALL) and lymphoma is increased we come across late complications from the treatment received. An important complication from the musculoskeletal system seems to be treatment-related osteonecrosis An important index of skeletal health in the adulthood is the normal developement during childhood. About 10-25% of children with ALL or lymphoma will present a decrease in their bone mass density, which may insist for more than 20 years. This effect seems multifactorial. Although osteopenia and osteonecrosis are known to have different pathophysiological mechanisms, osteonecrosis appears to be associated with an accelerated bone loss. Osteonecrosis may vary from asymptomatic to severe, which restrict the quality of life of the patients and may need surgical rehabilitation. Risk factors for osteonecrosis are: age >10 years, the female gender, high doses of corticosteroids, asparaginase, methotrexate, vincristine, hematopoietic stem cell transplantation and dyslipidaemia, Caucasian race and in some studies low albumin levels and high BMI are also associated. The joints which are affected more are: the shoulders (13-24%), the hip (35-67%), the knee (45-88%), the ankle (13-44%), the clavicles (3-15%) Treatment of osteonecrosis varies to the degree of the disease, varying from wait-and watch approach or conservative treatment to surgical rehabilitation of the joint. In conservative treatment the recommendation is that of partial activity, without weightlifting such as swimming or cycling under the supervision of a specialist physiotherapist. Thus, there is an improvement in osteosynthesis and stimulation for muscle building, while at the same time limiting weightlifting from the joints. ΠΜΣ Αιματολογία - Ογκολογία Παιδιών και Εφήβων Ιατρική Σχολή – Πανεπιστήμιο Κρήτης 7 Purpose We wanted to study in patients with ALL and lymphoma the complications from the treatment regarding the musculoskeletal system and especially the osteonecrosis. Methods In this study, the files of patients treated for ALL or lymphoma in the Department of Pediatric Hematology/Oncology of the University Hospital of Heraklion from 1/1/2006 to 31/12/2020 were evaluated, a total of 130 patients. Demographic characteristics, symptoms when they were present, location of lesions, imaging findings, data on disease and treatment, and BMI of each patient were recorded. Results Of the patients studied, 7.69% showed at least one serious complication from the musculoskeletal system. 6.15% had osteonecrosis confirmed by MRI scan, while 4.61% had symptomatic osteonecrosis. Asymptomatic osteonecrosis could not be evaluated due to lack of regular scan in patients without symptoms. The sex ratio for symptomatic osteonecrosis was 1: 1. All subjects were above the age of 10 years old, while the majority (62.5%) were over 16 years old at the diagnosis of malignancy. In this study, being overweight did not prove to increase the risk of osteonecrosis. All patients were exposed to high doses of corticosteroids, while 80% of those with severe musculoskeletal complications received asparaginase, 90% vincristine, and 40% high doses of methotrexate. Of those who had symptomatic osteonecrosis, 83% developed symptoms during the maintenance phase and 17% after the end of treatment. 75% of patients had osteonecrosis in more than one joint, while the most affected joint in this study was the hip. Finally, 25% of patients needed only follow-up, 12.5% conservative treatment, 37.5% needed surgical rehabilitation while the rest are still not sure of the outcome.
Language Greek
Subject Late complications
Malignancies
Απώτερες επιπλοκές
Νεοπλασία
Issue date 2022-03-30
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Permanent Link https://elocus.lib.uoc.gr//dlib/5/e/3/metadata-dlib-1651051496-9758-15585.tkl Bookmark and Share
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