The 2020 Pediatric Rheumatology Symposium, originally scheduled for April 29 – May 2, was postponed due to COVID-19; therefore, abstracts were not presented as scheduled.
Session Type: ACR Abstract Session
Session Time: 4:15PM-5:15PM
Background/Purpose: Osteonecrosis has emerged as debilitating complication of acute pediatric lymphoblastic leukemia (pALL), with severe pain and poor functional outcome. Patients with ON of weight bearing joints with > 50% surface involvement may eventually need surgery. Intravenous Pamidronate (IV-PAM) has been reported to be beneficial in some cases of idiopathic 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 of once/monthly IV-PAM (first dose 0.5 mg/kg; all others 1 mg/kg/dose, maximum dose 60 mg/dose). 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 with bone pain, all had osteoporosis and 24/40 had ON (9F:15M). Ten patients had ON lesions in upper and 20/24 in lower extremities; with ON affecting 26 large joints (shoulders , hips  and knees ). Four hip joints had >50% femoral head surface involvement, and 4 knee joints had >50 % 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.
Conclusion: Our results suggest that IV-PAM is effective in controlling ON related pain and may prevent joint ON progression and orthopedic surgery.
To cite this abstract in AMA style:Miettunen P, Stephenson C, Haider S, Stephenson S, Moorjani V, Anderson R. Use of Intravenous Pamidronate in Pediatric Leukemia Patients with Osteonecrosis Results in Reduced Pain and May Halt Osteonecrosis Progression [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 4). https://acrabstracts.org/abstract/use-of-intravenous-pamidronate-in-pediatric-leukemia-patients-with-osteonecrosis-results-in-reduced-pain-and-may-halt-osteonecrosis-progression/. Accessed December 4, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-intravenous-pamidronate-in-pediatric-leukemia-patients-with-osteonecrosis-results-in-reduced-pain-and-may-halt-osteonecrosis-progression/