Osteonecrosis after intensive chemotherapy for Hodgkin's disease

Avascular necrosis of bone following combination chemotherapy for acute lymphocytic leukemia

Avascular necrosis of bone (AVNB) is a known complication of systemic adrenocorticosteroid therapy, and one which is thought to be dose-related. However, despite the large amounts of prednisone which have been used in the standard treatment of acute lymphocytic leukemia (ALL), AVNB rarely has been reported in children with that disease. We described our experience with one adolescent with ALL who developed multifocal AVNB presenting as bone pain after aggressive chemotherapy that included a high cumulative dose of corticosteroids as well as other antitumor agents, some of which also have been associated with AVNB. Four similar cases from the literature are reviewed. Because the bone pain of AVNB can mimic that of leukemic relapse, this is an important entity to be aware of, and one which may become more common with increasingly aggressive combination chemotherapy.

Increasing frequency of acute myeloid leukemia complicating Hodgkin's disease: a review

Between the years 1911 and 1969, there were 16 reported cases of Hodgkin's disease terminating in acute myeloid leukemia. During the period from 1970 to 1978, the number reported was 161. Other severe complications of Hodgkin's disease (second malignancies and infections) also seem to appear with increased frequency after the introduction of modern aggressive high-energy radiation therapy and combination chemotherapy. It is thus desirable to search for alternative methods of treatment of Hodgkin's disease.