Polymorphism in the PAI-1 (SERPINE1) gene and the risk of osteonecrosis in children with acute lymphoblastic leukemia.

摘要

The success of modern therapy for childhood acute lymphoblastic leukemia (ALL) has led to an increased focus on avoidance of treatment-related morbidity in long-term survivors. It is clear that the prognosis for older patients in particular has been improved by protocols based on effective asparagine depletion and intensive exposure to corticosteroids, particularly dexamethasone. This improvement has come at a cost of increased rates of osteonecrosis (ON), which affects up to 15% of older children and young adults treated in recent trials. Some collaborative groups are sufficiently concerned about bone toxicity that they are opting to use alternative corticosteroid regimens in selected patients, at the potential expense of antileukemia efficacy.