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Master Thesis

Manifestations et complications orthopédiques dans la leucémie aiguë lymphoblastique de l'enfant : étude épidémiologique et thérapeutique

Abstract : Introduction: acute lymphoblastic leukemia (ALL) is the most frequent pediatric cancer, which can be revealed by different symptoms such as osteo-articular manifestations. ALL is a curable disease thanks to medical advances but several complications might occur, altering quality of life. The aim of this work was to provide an overview of musculo-skeletal manifestations at diagnosis, to report osteo-articular treatment-related complication and to investigate vertebral compression fractures treatment and evolution. Materials and methods: a retrospective study was conducted between 2007 and 2017 including all children diagnosed with ALL in 3 pediatric university hospitals. Patients suffering from another type of leukemia were excluded as well as ALL secondary to a syndrome. All the patients with orthopaedic manifestations at initial diagnosis and during treatment were reported. Radiological exams were analyzed. Regarding compression vertebral fractures, sagittal measures on full-spine standing radiographs were performed. Results: a total of 1293 children (mean age 6.8 ± 0.1-year-old) were diagnosed and treated for an ALL: 10.7% had orthopaedic manifestations at initial diagnosis (bone pain 76.7%, pathological fractures 16,7% and arthritis 6.6%). In 118 cases, radiological exams were performed showing radiolucent metaphyseal bands, osteolysis, periosteal reactions and diffuse bone demineralization. Orthopedic complications were found in 10% (n=129) with a mean follow-up of 4.3 years (osteonecrosis 54.3% and osteopenia 45.7%). Regarding osteopenia, patients received oral Vitamin D and calcium supplementation and intravenous bisphosphonates for 11 patients with confirmed osteoporosis. Surgical treatment was performed in 3.1% for epiphyseal necrosis with articular damages. Several risk factors were identified: relapses and bone marrow graft, as well as high dose of corticoids for osteonecrosis. Among the global population, 2.2% had vertebral compression fractures, treated conservatively (including 16 patients with brace). At last follow-up, patients had a correct global alignment and traumatic vertebral angle showed improvement due to remodeling effects. Conclusion: orthopaedic manifestations are frequent and the diagnosis of ALL should be raised in front of a child with loss of condition and musculo-skeletal symptoms. These patients should be urgently addressed for further management. Orthopaedic complications are reversible in most of the cases, except for epiphyseal necrosis. Vertebral compression fractures, even multistage have a good prognosis with no global misalignment at final follow-up, with or without treatment. Therefore, patients and parents should be reassured during treatment.
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Pauline Savidan. Manifestations et complications orthopédiques dans la leucémie aiguë lymphoblastique de l'enfant : étude épidémiologique et thérapeutique. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02492009⟩

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