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The incidence was higher for older children (\u2265 10 years: 14.2% \u00b1 1.3% v &lt; 10 years: 0.9% \u00b1 0.4%; P &lt; .0001), especially females 10 to 15 years old and males 16 to 20 years old (19.2% \u00b1 2.3% and 20.7% \u00b1 4.7%, respectively). In patients 10 to 20 years old, the incidence of ON was higher for females versus males (17.4% \u00b1 2.1% v 11.7% \u00b1 1.6%, respectively; P = .03) and for patients randomized to receive two 21-day dexamethasone courses versus one course (23.2% \u00b1 4.8% v 16.4% \u00b1 4.3%, respectively; P = .27). Among ethnic groups, whites had the highest incidence and blacks the lowest, with other groups intermediate (16.7% \u00b1 1.4% v 3.3% \u00b1 2.3% v 6.7% \u00b1 2.2%, respectively; P = .003). There was no difference in event-free survival in patients with or without ON. ON was diagnosed within 3 years of starting ALL therapy in all but one patient, involved weight-bearing joint(s) in 94% of patients, and was multifocal in 74% of patients. Symptoms of pain and\/or immobility were chronic in 84% of patients, with 24% having undergone an orthopedic procedure and an additional 15% considered candidates for surgery in the future.<\/jats:p>\n                  <jats:p>CONCLUSION: Children ages 10 to 20 years who receive intensive ALL therapy, including multiple courses of corticosteroid, are at significant risk for developing ON.<\/jats:p>","DOI":"10.1200\/jco.2000.18.18.3262","type":"journal-article","created":{"date-parts":[[2017,2,24]],"date-time":"2017-02-24T04:28:35Z","timestamp":1487910515000},"page":"3262-3272","source":"Crossref","is-referenced-by-count":340,"title":["Osteonecrosis as a Complication of Treating Acute Lymphoblastic Leukemia in Children: A Report From the Children\u2019s Cancer Group"],"prefix":"10.1200","volume":"18","author":[{"suffix":"Jr","given":"Leonard A.","family":"Mattano","sequence":"first","affiliation":[{"name":"From the Michigan State University\/Kalamazoo Center for Medical Studies, Kalamazoo, MI; Children\u2019s Cancer Group, Los Angeles, CA; Dupont Hospital for Children, Jefferson Medical College, Wilmington, DE; and University of Chicago Medical Center, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harland N.","family":"Sather","sequence":"additional","affiliation":[{"name":"From the Michigan State University\/Kalamazoo Center for Medical Studies, Kalamazoo, MI; Children\u2019s Cancer Group, Los Angeles, CA; Dupont Hospital for Children, Jefferson Medical College, Wilmington, DE; and University of Chicago Medical Center, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Trigg","sequence":"additional","affiliation":[{"name":"From the Michigan State University\/Kalamazoo Center for Medical Studies, Kalamazoo, MI; Children\u2019s Cancer Group, Los Angeles, CA; Dupont Hospital for Children, Jefferson Medical College, Wilmington, DE; and University of Chicago Medical Center, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James B.","family":"Nachman","sequence":"additional","affiliation":[{"name":"From the Michigan State University\/Kalamazoo Center for Medical Studies, Kalamazoo, MI; Children\u2019s Cancer Group, Los Angeles, CA; Dupont Hospital for Children, Jefferson Medical College, Wilmington, DE; and University of Chicago Medical Center, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"R1-0433","doi-asserted-by":"crossref","unstructured":"Bassett LW, Mirra JM, Cracchiolo A III, et al: Ischemic necrosis of the femoral head. 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