Is there a risk of early relapse in patients with acute lymphoblastic leukemia presenting with bone-associated symptoms?

Children with bone pain

Authors

Keywords:

leukemia, childhood, bone involvement

Abstract

Background/Aim: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. Patients usually present with fatigue, pallor, weight loss, and joint and/or bone findings. However, the effects of bone-associated symptoms on prognosis remains controversial. We aimed to demonstrate whether bone-associated symptoms affect prognosis in children with ALL.

Methods: This retrospective cohort study included the data from 268 patients with ALL who were diagnosed and treated between January 2011 and December 2020. The patients were divided into two groups as those with and without bone-associated symptoms. We compared the groups in terms of age, gender, immunophenotyping, day 8 prednisolone response, and risk groups, in addition to minimal residual disease (MRD), relapse, and survival rates.

Results: Eighty-five out of 268 (32%) children had bone-associated symptoms at the time of diagnosis, whereas others (n=183) had none of these symptoms. The relapse rate in children with bone-associated symptoms was found to be higher than the others (17.6% versus 12%), but the difference was not significant (P=0.24). However, children with bone findings developed earlier relapse when compared with the others (18.6 versus 28.6 months; P<0.001).

Conclusion: Therefore, we suggest that bone-associated symptoms at the time of diagnosis could be considered a warning sign for earlier relapse, and these children should be carefully followed.

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References

Stanulla M, Schrappe M. Treatment of childhood acute lymphoblastic leukemia. In: Seminars in hematology. Elsevier; 2009. p. 52–63. DOI: https://doi.org/10.1053/j.seminhematol.2008.09.007

Pui CH. Childhood leukemias. 3rd. 2012. DOI: https://doi.org/10.1017/CBO9780511977633

Zombori L, Kovacs G, Csoka M, Derfalvi B. Rheumatic symptoms in childhood leukaemia and lymphoma-a ten-year retrospective study. Pediatric Rheumatology. 2013;11:1–5. DOI: https://doi.org/10.1186/1546-0096-11-20

Kang S, Im HJ, Bae K, Park S-S. Influence of musculoskeletal manifestations as the only presenting symptom in B-cell acute lymphoblastic leukemia. The Journal of Pediatrics. 2017;182:290–5. DOI: https://doi.org/10.1016/j.jpeds.2016.11.072

Sinigaglia R, Gigante C, Bisinella G, Varotto S, Zanesco L, Turra S. Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop. 2008;28:20–8. DOI: https://doi.org/10.1097/BPO.0b13e31815ff350

Apak A, Celkan T, Yıldız I, Zeybek C, Özkan A, Yüksel L, et al. Akut lenfoblastik lösemide iyi prognoz göstergesi; kemik tutulumu. Cocuk Sagligi Hast Derg. 2003;46:275–80.

Maman E, Steinberg DM, Stark B, Izraeli S, Wientroub S. Acute lymphoblastic leukemia in children: correlation of musculoskeletal manifestations and immunophenotypes. Journal of Children’s Orthopaedics. 2007;1:63–8. DOI: https://doi.org/10.1007/s11832-007-0013-9

Robazzi TCMV, Barreto JH, Silva LR, Santiago MB, Mendonça N. Osteoarticular manifestations as initial presentation of acute leukemias in children and adolescents in Bahia, Brazil. Journal of pediatric hematology/oncology. 2007;29:622–6. DOI: https://doi.org/10.1097/MPH.0b013e3181468c55

Clarke RT, Van den Bruel A, Bankhead C, Mitchell CD, Phillips B, Thompson MJ. Clinical presentation of childhood leukaemia: a systematic review and meta-analysis. Archives of Disease in Childhood. 2016;101:894–901. DOI: https://doi.org/10.1136/archdischild-2016-311251

Louvigné M, Rakotonjanahary J, Goumy L, Tavenard A, Brasme J-F, Rialland F, et al. Persistent osteoarticular pain in children: early clinical and laboratory findings suggestive of acute lymphoblastic leukemia (a multicenter case-control study of 147 patients). Pediatric Rheumatology. 2020;18:1–8. DOI: https://doi.org/10.1186/s12969-019-0376-8

Révész T, Kardos G, Kajtár P, Schuler D. The adverse effect of prolonged prednisolone pretreatment in children with acute lymphoblastic leukemia. Cancer. 1985;55:1637–40. DOI: https://doi.org/10.1002/1097-0142(19850415)55:8<1637::AID-CNCR2820550804>3.0.CO;2-H

Zhou F, Zhang M, Han J, Hao J, Xiao Y, Liu Q, et al. Skeletal abnormalities detected by SPECT is associated with increased relapse risk in pediatric acute lymphoblastic leukemia. Oncotarget. 2017;8:79347. DOI: https://doi.org/10.18632/oncotarget.18110

Müller HL, Horwitz AE, Kühl J. Acute lymphoblastic leukemia with severe skeletal involvement: a subset of childhood leukemia with a good prognosis. Pediatric Hematology and Oncology. 1998;15:121–33. DOI: https://doi.org/10.3109/08880019809167227

Halton JM, Atkinson SA, Fraher L, Webber CE, Cockshott WP, Tam C, et al. Mineral homeostasis and bone mass at diagnosis in children with acute lymphoblastic leukemia. The Journal of Pediatrics. 1995;126:557–64. DOI: https://doi.org/10.1016/S0022-3476(95)70349-7

Tragiannidis A, Vasileiou E, Papageorgiou M, Damianidou L, Hatzipantelis E, Gombakis N, et al. Bone involvement at diagnosis as a predictive factor in children with acute lymphoblastic leukemia. Hippokratia. 2016;20:227.

BK AR, Singh KA, Shah H. Orthopedic manifestation as the presenting symptom of acute lymphoblastic leukemia. Journal of Orthopaedics. 2020;22:326–30. DOI: https://doi.org/10.1016/j.jor.2020.05.022

Radu L-E, Colita A, Pasca S, Tomuleasa C, Popa C, Serban C, et al. Day 15 and day 33 minimal residual disease assessment for acute lymphoblastic leukemia patients treated according to the BFM ALL IC 2009 protocol: Single-center experience of 133 cases. Frontiers in oncology. 2020;10:923. DOI: https://doi.org/10.3389/fonc.2020.00923

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Published

2023-01-17

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Research Article

How to Cite

1.
Temuroğlu A, Güler S, Aksoy GR, Evim MS, Güneş AM. Is there a risk of early relapse in patients with acute lymphoblastic leukemia presenting with bone-associated symptoms? Children with bone pain. J Surg Med [Internet]. 2023 Jan. 17 [cited 2024 May 25];7(1):40-3. Available from: https://jsurgmed.com/article/view/1090164