The prognostic significance of the skeletal manifestations of acute lymphoblastic leukemia of childhood

Stephen D. Heinrich, Daniel Gallagher, Raj Warrior, Kathy Phelan, Varghese T. George, G. Dean Macewen

Research output: Contribution to journalArticle

47 Scopus citations


The variety and distribution of skeletal pathology in children with acute lymphoblastic leukemia is rarely seen in other disease states. Skeletal radiographic changes associated with and/or suggestive of acute leukemia include diffuse osteopenia, metaphyseal bands, periosteal new bone formation, geographic lytic lesions, sclerosis, mixed sclerosisAysis, and permeative destruction. This retrospective analysis of 83 children with acute lymphoblastic leukemia suggests that children without radiographic skeletal abnormalities have an "aggressive" form of leukemia. Children with one to four lesions have an "indolent" form of leukemia that is of short duration. Children with five or more lesions have an indolent form of leukemia that is of longer duration. The longer duration of symptoms before diagnosis reduces the survival rate to that of the aggressive form of leukemia. It is therefore imperative that physicians who treat children recognize the orthopaedic/radiographic manifestations of acute leukemia (the most common pediatric malignancy) to facilitate diagnosis, and, thereby, improve survival.

Original languageEnglish (US)
Pages (from-to)105-111
Number of pages7
JournalJournal of Pediatric Orthopaedics
Issue number1
Publication statusPublished - Jan 1 1994
Externally publishedYes



  • Lymphoblastic leukemia
  • Skeletal involvement
  • Survival

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

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