Investigators at St. Jude Children's Research Hospital say they have found the best way for predicting when patients will need future surgery to repair hip joints that have deteriorated because of pediatric leukemia or lymphoma treatment.

The investigators found that if more than 30 percent of the head of the bone fitting into the hip socket is deteriorated, it is at high risk of collapsing and requiring reconstructive surgery within two years.

The study is significant because the intensive use of corticosteroid drugs that have been implicated in development of osteonecrosis, or bone deterioration, is a major component of chemotherapy for pediatric leukemia and lymphoma. The drugs have been key to raising the survival rates of children with these cancers, and currently there is no adequate substitute for their use. Therefore, it is important for clinicians to monitor patients during treatment and identify those most at risk for this complication. Eventually, genetic or other tests may be developed to help predict these patients. This is a subject of ongoing study.

A report on this work appears in the April 20 issue of "Journal of Clinical Oncology."

"Being able to predict which children are likely to experience serious bone deterioration in the future will help investigators identify and monitor those survivors who are at particularly high risk for developing this problem," said Sue Kaste, D.O., a member of the Radiological Sciences department at St. Jude. Kaste is the paper's senior author.

Collapse of the femur causes severe pain that might leave the patient wheelchair bound, according to Evguenia Jane Karimova, M.D., Radiological Sciences department at St. Jude and the paper's first author. "To ease the pain, many patients require arthroplasty, or surgery to rebuild the hip joint," she said.

Other authors of this study are Shesh N. Rai, Scott C. Howard, Michael Neel, Lunetha Britton and Ching-Hon Pui.

This work was supported by the National Institutes of Health, the American Cancer Society and ALSAC.

St. Jude Children's Research Hospital

St. Jude Children's Research Hospital is internationally recognized for its pioneering work in finding cures and saving children with cancer and other catastrophic diseases. Founded by late entertainer Danny Thomas and based in Memphis, Tenn., St. Jude freely shares its discoveries with scientific and medical communities around the world. No family ever pays for treatments not covered by insurance, and families without insurance are never asked to pay. St. Jude is financially supported by ALSAC, its fundraising organization. For more information, please visit http://www.stjude.org/.