AVASCULAR NECROSIS IN CHRONIC MYELOID LEUKEMIA: A REVIEW OF PATHOPHYSIOLOGY, PATIENTS’ CHARACTERISTICS, AND CLINICAL OUTCOMES

Abstract

Objective: The exact incidence of avascular necrosis (AVN) in chronic myeloid leukemia (CML) is still unknown as the number of cases is limited. AVN was reported as an initial presenting manifestation in few CML patients. On the other hand, AVN was linked to medications used in CML treatment, specifically interferon-alpha (IFN-α) therapy and tyrosine kinase inhibitors (TKI). Our review aims to describe the pathophysiology, patients’ clinical characteristics, and outcomes of AVN in CML. Methodology: We searched PubMed and Google Scholar for the case reports and series of patients with CML who developed AVN from inception to July 2021. We found 21 cases of AVN in CML patients,17 cases with AVNFH, and four cases with ONJ. Articles in the grey literature and non-English language publications were excluded. Patient characteristics, hematological parameters, management, and outcomes of AVN were extracted from those articles. Results: The median age was 39 years with an almost equal distribution between males and females. WBC counts were strikingly elevated in patients who initially presented with AVNFH (above 10,0000 in most cases). AVN related to CML management has been linked to TKIs and standard IFN-α therapies. Only 6 (out of 17) patients who developed AVNFH eventually required a hip replacement, and one (out of 17) developed a recurrent episode of AVNFH. All the reported cases of CML with ONJ were associated with TKIs Conclusion: Given the lack of data, we could not conclude whether AVN has an adverse prognostic effect on CML. However, the overall prognosis is comparable with AVN associated with other conditions. Clinicians should consider AVN in CML patients with either hip or jaw pain because early detection and management are essential to decrease morbidity and long-term disability in such patients. A further prospective study with a larger sample size is needed to clarify the different aspects of AVN in CML patients.