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Four children with leukemia (1.6% of all leukemia patients) treated between 1979 and 1984 developed aseptic bone necroses, all of them at multiple sites. The average time from starting chemotherapy to developing bone necroses has been 19 months (range 9 to 28 months). This is a well known complication of corticoid therapy, but corticoids may not be the only aetiological factor. Other antineoplastic agents and leukemia for itself have been associated with aseptic bone necroses. Bone and joint pain caused by aseptic bone necroses can mimic leukemic relapse, so the diagnosis may be difficult. The increasing number of long term survivors in childhood leukemia, who underwent aggressive polychemotherapy, could make this problem more common in the near future.
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