Radiation-induced bone abnormalities after bone marrow transplantation for childhood leukemia

PURPOSE: To identify bone abnormalities related to total-body irradiation (TBI) in long-term survivors of bone marrow transplantation (BMT) for childhood leukemia. MATERIALS AND METHODS: The authors obtained skeletal surveys of 10 survivors of childhood leukemia, ages 5-27 years, who had undergone BMT 7-9 years previously. Pretransplantation 'conditioning' regimens were composed of chemotherapy and TBI in doses of 12 or 14.4 Gy. RESULTS: Of the six survivors who received TBI before age 8 years, five had osteochondromas and three had metaphyseal growth abnormalities. One also had slipped femoral capital epiphysis. Findings in the four remaining patients, who received TBI at ages 12-19 years, were less severe and less clearly related to TBI (mild scoliosis in two cases, avascular necrosis of the femoral condyles in one, and a femoral enchondroma in one). CONCLUSIONS: Skeletal abnormalities, previously recognized as sequelae of local external- beam irradiation in children, may occur in long-term survivors of BMT who have received TBI. Younger patients appear to be at the greatest risk.