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Radiological follow-up of osteonecrosis lesions in children and adolescents with Hodgkin lymphoma

Aarnivala, Henri ; Giertz, Mia ; Michelsen, Sascha Wilk ; Björklund, Caroline ; Englund, Annika ; Grönroos, Marika ; Hjalgrim, Lisa Lyngsie ; Huttunen, Pasi ; Niinimäki, Tuukka and Penno, Eva , et al. (2024) In British Journal of Haematology 205(4). p.1460-1468
Abstract

Osteonecrosis (ON) is a common complication of glucocorticoid-based Hodgkin lymphoma (HL) treatment, but the natural evolution and prognosis of ON lesions remain poorly understood. We describe the radiological evolution of ON lesions identified in a Nordic population-based cohort of paediatric HL patients. Magnetic resonance images of suspected ON lesions were centrally reviewed to confirm ON diagnosis and grade the ON lesions according to the Niinimäki classification. The study included 202 ON lesions in 46 patients, of which 77 were joint lesions. Follow-up images were available for 146/202 lesions, with a mean follow-up time of 28 months. During follow-up, 71% of the lesions remained stable, 26% improved or resolved, and 3%... (More)

Osteonecrosis (ON) is a common complication of glucocorticoid-based Hodgkin lymphoma (HL) treatment, but the natural evolution and prognosis of ON lesions remain poorly understood. We describe the radiological evolution of ON lesions identified in a Nordic population-based cohort of paediatric HL patients. Magnetic resonance images of suspected ON lesions were centrally reviewed to confirm ON diagnosis and grade the ON lesions according to the Niinimäki classification. The study included 202 ON lesions in 46 patients, of which 77 were joint lesions. Follow-up images were available for 146/202 lesions, with a mean follow-up time of 28 months. During follow-up, 71% of the lesions remained stable, 26% improved or resolved, and 3% progressed. A higher ON grade at diagnosis was associated with a lower likelihood of spontaneous resolution. The likelihood for resolution of ON decreased by 50% for each year of added patient age, when adjusted for sex, ON location, and symptoms. Hip ON showed less spontaneous improvement compared with other joints, and the risk for surgery was 13-fold in hip ON. Grades 3–4 joint ON has the potential to either progress or resolve, warranting follow-up in patients with severe symptoms. Research on secondary prevention should be directed at grade 3–4 joint ON.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
avascular necrosis, Hodgkin lymphoma, osteonecrosis, paediatric
in
British Journal of Haematology
volume
205
issue
4
pages
9 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:39096138
  • scopus:85200244157
ISSN
0007-1048
DOI
10.1111/bjh.19687
language
English
LU publication?
yes
id
6b7de3d8-82e7-4046-823d-9b40f64067eb
date added to LUP
2024-11-04 14:32:24
date last changed
2025-07-15 12:30:57
@article{6b7de3d8-82e7-4046-823d-9b40f64067eb,
  abstract     = {{<p>Osteonecrosis (ON) is a common complication of glucocorticoid-based Hodgkin lymphoma (HL) treatment, but the natural evolution and prognosis of ON lesions remain poorly understood. We describe the radiological evolution of ON lesions identified in a Nordic population-based cohort of paediatric HL patients. Magnetic resonance images of suspected ON lesions were centrally reviewed to confirm ON diagnosis and grade the ON lesions according to the Niinimäki classification. The study included 202 ON lesions in 46 patients, of which 77 were joint lesions. Follow-up images were available for 146/202 lesions, with a mean follow-up time of 28 months. During follow-up, 71% of the lesions remained stable, 26% improved or resolved, and 3% progressed. A higher ON grade at diagnosis was associated with a lower likelihood of spontaneous resolution. The likelihood for resolution of ON decreased by 50% for each year of added patient age, when adjusted for sex, ON location, and symptoms. Hip ON showed less spontaneous improvement compared with other joints, and the risk for surgery was 13-fold in hip ON. Grades 3–4 joint ON has the potential to either progress or resolve, warranting follow-up in patients with severe symptoms. Research on secondary prevention should be directed at grade 3–4 joint ON.</p>}},
  author       = {{Aarnivala, Henri and Giertz, Mia and Michelsen, Sascha Wilk and Björklund, Caroline and Englund, Annika and Grönroos, Marika and Hjalgrim, Lisa Lyngsie and Huttunen, Pasi and Niinimäki, Tuukka and Penno, Eva and Pokka, Tytti and Pöyhönen, Tuuli and Raittinen, Päivi and Ranta, Susanna and Svahn, Johan E. and Törnudd, Lisa and Harila, Arja and Niinimäki, Riitta}},
  issn         = {{0007-1048}},
  keywords     = {{avascular necrosis; Hodgkin lymphoma; osteonecrosis; paediatric}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{1460--1468}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{British Journal of Haematology}},
  title        = {{Radiological follow-up of osteonecrosis lesions in children and adolescents with Hodgkin lymphoma}},
  url          = {{http://dx.doi.org/10.1111/bjh.19687}},
  doi          = {{10.1111/bjh.19687}},
  volume       = {{205}},
  year         = {{2024}},
}