{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T14:54:46Z","timestamp":1791125686696,"version":"4.1.0"},"reference-count":39,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2007,4,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> The aim of the study was to determine the incidence of and clinical risk factors for radiographic osteonecrosis (ON) in children treated for acute lymphoblastic leukemia (ALL) using the Nordic ALL protocols. <\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p> Ninety-seven consecutive patients with childhood ALL were studied prospectively by magnetic resonance imaging (MRI) of the lower extremities at the end of the treatment. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Twenty-three (24%) of the 97 patients had ON. Seven of the patients (30%) were symptomatic, and three patients (13%) required surgical interventions. Multiple logistic regression analysis showed that high body mass index (BMI; P = .04), female sex (P = .01), older age at diagnosis (P &lt; .001), and higher cumulative dexamethasone dose (P = .03) were independent risk factors for radiographic ON. The cumulative prednisone dose did not differ significantly between the patients with and without ON. The incidence of radiographic ON decreased significantly, from 36% to 7%, when the duration of dexamethasone exposure during the delayed-intensification phase was shortened from 3 to 4 weeks to 2 weeks with a taper (P = .001). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> ON as determined by MRI was found to be a common complication in children and adolescents after treatment with the Nordic ALL protocols. Revision of the ALL protocols by shortening the single exposure to dexamethasone has diminished the risk for ON remarkably. High BMI was identified as a new significant risk factor for ON. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2006.06.2539","type":"journal-article","created":{"date-parts":[[2007,4,18]],"date-time":"2007-04-18T22:28:15Z","timestamp":1176935295000},"page":"1498-1504","source":"Crossref","is-referenced-by-count":103,"title":["High Body Mass Index Increases the Risk for Osteonecrosis in Children With Acute Lymphoblastic Leukemia"],"prefix":"10.1200","volume":"25","author":[{"given":"Riitta A.","family":"Niinim\u00e4ki","sequence":"first","affiliation":[{"name":"From the Departments of Pediatrics and Radiology, Oulu University Hospital, Oulu; and the Departments of Radiology and Pediatrics, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arja H.","family":"Harila-Saari","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and Radiology, Oulu University Hospital, Oulu; and the Departments of Radiology and Pediatrics, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Airi E.","family":"Jartti","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and Radiology, Oulu University Hospital, Oulu; and the Departments of Radiology and Pediatrics, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raija M.","family":"Seuri","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and Radiology, Oulu University Hospital, Oulu; and the Departments of Radiology and Pediatrics, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pekka V.","family":"Riikonen","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and Radiology, Oulu University Hospital, Oulu; and the Departments of Radiology and Pediatrics, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eija L.","family":"P\u00e4\u00e4kk\u00f6","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and Radiology, Oulu University Hospital, Oulu; and the Departments of Radiology and Pediatrics, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merja I.","family":"M\u00f6tt\u00f6nen","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and Radiology, Oulu University Hospital, Oulu; and the Departments of Radiology and Pediatrics, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjatta","family":"Lanning","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and Radiology, Oulu University Hospital, Oulu; and the Departments of Radiology and Pediatrics, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20011001)92:7<1977::AID-CNCR1717>3.0.CO;2-W"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199808273390907"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.18.3262"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.12.3066"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19900415)65:8<1717::AID-CNCR2820650809>3.0.CO;2-B"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-911X(199710)29:4<260::AID-MPO5>3.0.CO;2-K"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.3109\/08880019809014014"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199205283262206"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-911X(199901)32:1<11::AID-MPO4>3.0.CO;2-F"},{"key":"R10","unstructured":"Arico M, Boccalatte MF, Silvestri D, et al: Osteonecrosis: An emerging complication of intensive chemotherapy for childhood acute lymphoblastic leukemia. Haematologica 88:747,2003-753,"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20244"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198971050-00003"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2004.04.014"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.162.3.3809484"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2402139"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9260(98)80060-3"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-199502000-00001"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3046.7.s3.11.x"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1990.tb11503.x"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2271"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199709253371301"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1984.tb09965.x"},{"key":"R23","unstructured":"Salo M, Angl\u00e9 S, Kaukua J, et al: [Lasten lihavuus] Current care guidelines in Finland 2005: Childhood obesity. Duodecim 121:2015,2005-2024,"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2401961"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1998.tb00923.x"},{"key":"R26","unstructured":"Haynes RC Jr, Murad F: Adrenocorticotropic hormone; adrenocortical steroids and their analogs; inhibitors of adrenocortical steroid biosynthesis, in Gilman AG, Goodman LS, Rall TW, et al (eds): The Pharmacological Basis of Therapeutics (ed 7) . New York, NY, Macmillan Publishing Company, pp 1459,1985-1489"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.86.9.7760"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(98)70433-0"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2004.10.003"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197759060-00003"},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(01)00663-9"},{"key":"R32","doi-asserted-by":"crossref","unstructured":"Vegna ML: Avascular necrosis of the femoral head in acute leukemia patients treated with combination therapy including steroids. Eur J Haematol 42:209,1989-211,","DOI":"10.1111\/j.1600-0609.1989.tb01213.x"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.1007\/BF00445806"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.288.6413.267"},{"key":"R35","doi-asserted-by":"crossref","unstructured":"Obrist R, Hartmann D, Obrecht JP: Osteonecrosis after chemotherapy. Lancet 1:1316,1978,","DOI":"10.1016\/S0140-6736(78)91306-5"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2005.05509.x"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.2950190411"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-08-2454"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.7.1570"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.2006.06.2539","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T20:03:29Z","timestamp":1653509009000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.2006.06.2539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,4,20]]},"references-count":39,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2007,4,20]]}},"alternative-id":["10.1200\/JCO.2006.06.2539"],"URL":"https:\/\/doi.org\/10.1200\/jco.2006.06.2539","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,4,20]]}}}