Osteonecrosis detected by whole body magnetic resonance in patients with Hodgkin Lymphoma treated by BEACOPP
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The purpose of our retrospective review of prospectively acquired Whole Body Magnetic Resonance (WB-MRI) scans was to assess the incidence of osteonecrosis in patients who received different chemotherapies.
We evaluated the WB-MRI scans performed on 42 patients with Hodgkin Lymphoma treated by three chemotherapy regimens (6ABVD, 2ABVD + 4BEACOPP, 2ABVD + 8BEACOPP), excluding patients with the main risk factors for osteonecrosis.
Six out of seven patients (86 %) who received eight BEACOPP and one out of five patients (20 %) treated by four BEACOPP presented osteonecrosis, with a statistically significant difference of frequency between the two groups of patients (p < 0.05); no injury has been reported in patients treated by only ABVD. Among a total of 48 osteonecrotic lesions observed, 48 % were detected in the knee; multifocal osteonecrosis were detected in six out of seven patients (86 %).
The development of osteonecrosis is strictly related to the chemotherapy protocol adopted and the number of cycles received, with a strong correlation between the dose of corticosteroids included in the BEACOPP scheme and this complication. WB-MRI can be considered as a helpful tool that allows detecting earlier osteonecrotic lesions in patients treated with corticosteroids.
• Osteonecrosis is a possible complication of patients with Lymphoma treated by chemotherapy.
• Osteonecrosis is related to the corticosteroids included within the BEACOPP protocol.
• WB-MRI allows detecting osteonecrotic lesions in patients treated with corticosteroids.
KeywordsMagnetic resonance imaging Whole body imaging Lymphoma Osteonecrosis BEACOPP
Doxorubicin, Bleomycin, Vinblastine and Dacarbazine
Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, Prednisone
Whole Body Magnetic Resonance
Fluorodeoxyglucose-Positron Emission Tomography/Computed tomography
The scientific guarantor of this publication is Prof. Massimo Galia. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. The Ethics Board granted exempt status for this retrospective study with a waiver of the requirement for informed consent. Methodology: retrospective, diagnostic study, performed at one institution.
- 7.Gianni AM, Rambaldi A, Zinzani PL, Levis A, Brusamolino E, Pulsoni A (2008) Comparable 3-year outcome following ABVD or BEACOPP first-line chemotherapy, plus pre-planned high-dose salvage, in advanced Hodgkin lymphoma (HL): a randomized trial of the GITIL and IIL cooperative groups [abstract]. J Clin Oncol 26:abstr 8506CrossRefGoogle Scholar
- 9.Behringer K, Breuer K, Reineke T et al (2005) Secondary amenorrhea after Hodgkin’s lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 23:7555–7564CrossRefPubMedGoogle Scholar
- 20.Bauer K, Skoetz N, Monsef I, Engert A, Brillant C (2011) Comparison of chemotherapy including escalated BEACOPP versus chemotherapy including ABVD for patients with early unfavourable or advanced stage Hodgkin lymphoma. Cochrane Database Syst Rev 10:CD007941Google Scholar
- 30.Hong TS, Shammas A, Navarro OM, Punnett A (2010) Osteonecrosis in an adolescent with non-Hodgkin lymphoma resembling a new metastatic lesion on (18)F-FDG PET/CT. Pediatr Radiol 40:S27–S29Google Scholar