Searchable abstracts of presentations at key conferences on calcified tissues
Bone Abstracts (2019) 7 P131 | DOI: 10.1530/boneabs.7.P131

ICCBH2019 Poster Presentations (1) (226 abstracts)

Use of intravenous pamidronate in pediatric acute lymphoblastic leukemia patients with osteonecrosis (ON) results in reduced pain and improved radiologic outcome of ON lesions: Long- term follow-up over 15-years

Paivi Miettunen , Vijay Moorani , Seemab Haider , Seamus Stephenson , Chloe Stephenson & Ronald Anderson

ACH and University of Calgary, Calgary, Canada.

Background: Osteonecrosis (ON) has emerged as a debilitating complication of acute pediatric lymphoblastic leukemia (pALL), with severe pain and poor functional outcome. ON affecting weight bearing joints may eventually need arthroplasty, with large juxta-articular lesions being at highest risk. Intravenous Pamidronate (IV-PAM) is postulated to reduce pain and prevent joint collapse in ON.

Objective: To study if IV-PAM was effective in 1) preventing joint ON progression and need for surgical intervention and in 2) reducing ON related pain in pALL.

Methods: All consecutive pALL patients (0–18 years) who developed bone pain were assessed for ON with a whole body MRI (WB-MRI). Patients with confirmed ON received two 9-month courses (induction and maintenance) of once/monthly IV-PAM (first dose 0.5 mg/kg; all others 1 mg/kg per dose; maximum dose 11.5 mg/mg per year). Visual analogue score for pain (VAS), with ‘0’ being ‘no-pain’ and ‘10’ being ‘the worst possible pain’ was administered at baseline, 3, 6 and 12 months and yearly. The radiologic outcome was assessed by serial WB-MRIs.

Results: Out of 40 pALL patients referred for assessment of bone pain, all had osteoporosis and 24/40 had ON (9F:15M). ON was multisite in 24/24; with 10/24 having upper limb and 20/24 having lower limb lesions. ON affected 26 large joints (shoulders [10], hips [4] and knees [12]). Four hips, knees and ankles had >50% articular surface involvement by ON. The mean duration of follow-up was 7 (range 3–15) years. None of the large joint ON required surgery: two femoral heads developed minor collapse, while other ON lesions remained stable or resolved. The mean pain VAS pre-pamidronate was 8.5/10 (range 8–10/10; 0.1/10 (range 0–1/10) at 6 months, and unchanged at 0. 08/10 (range 0–1/10) at 12 months and at final follow-up.

Conclusions: Our results suggest that IV-PAM is effective in controlling ON related pain and may prevent joint ON progression and orthopedic surgery.

Disclosure: The authors declared no competing interests.

Volume 7

9th International Conference on Children's Bone Health


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