BACKGROUND: Reduced bone mineral density and increased fracture risk have been reported in children with cancer. In this study, we aimed to determine the growth and bone mineral density (BMD) of the children off chemotherapy for acute lymphoblastic leukemia, and the probable risk blogger.com by: 29 Bone mineral density at diagnosis determines fracture rate in children with acute lymphoblastic leukemia treated according to the DCOG-ALL9 protocol. te Winkel ML (1), Pieters R (2), Hop WC (3), Roos JC (4), Bökkerink JP (5), Leeuw JA (6), Bruin MC (7), Kollen WJ (8), Veerman AJ (9), de Groot-Kruseman HA (10), van der Sluis IM (1), van den Heuvel-Eibrink MM (11).Cited by: 40 Normal bone mineral density after treatment for childhood acute lymphoblastic leukemia diagnosed between and Nina Kadan-Lottick, MD, Julie A. Marshall, PhD, Anna E. Barón, PhD, Nancy F. Krebs, MD, K. Michael Hambidge, MD, and Edythe Albano, MD Acute lymphoblastic leukemia is the Objective: We investigated whether previous reports of reduced bone min- most common pediatric
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Download PDF. Download Full PDF Package This paper. A short summary of this paper. READ PAPER. Normal bone mineral density after treatment for childhood acute lymphoblastic leukemia diagnosed between and Normal bone mineral density after treatment for childhood acute lymphoblastic leukemia diagnosed between and Nina Kadan-Lottick, MD, Julie A. Marshall, PhD, Anna E. Barón, PhD, Nancy F.
Krebs, MD, K. Michael Hambidge, MD, and Edythe Albano, MD Acute lymphoblastic leukemia is the Objective: We investigated whether previous reports of reduced bone min- most common pediatric malignancy.
eral density after management for childhood acute lymphoblastic leukemia The overall 5-year survival rate exceeds chALL were confirmed in a more recently treated cohort. A significant positive association was found with whole body BMDA E, and osteoblast inhibiting factor.
Corticosteroids, methotrex- days hospitalized. Conclusion: Contrary to previous reports in which cranial radiation and ALL Acute lymphoblastic leukemia longer hospitalizations were prominent components of therapy, our bone density in acute leukemia BMD Bone mineral density BMDA Areal bone mineral density suggests that more recently treated patients with chALL do not have persis- BMI Body mass index tent abnormalities of bone mineral density after completion of therapy.
J chALL Childhood acute lymphoblastic leukemia Pediatr ; Past studies have investigated bone changes in patients with chALL. Sever- al studies demonstrated loss of bone From the Division of Pediatric Hematology-Oncology, Department of Pediatrics; the Department of Preventive mass during therapy and concluded Medicine and Biometrics, School of Medicine; and the Division of Nutrition, bone density in acute leukemia, Department of Pediatrics, University of Colorado Health Sciences Center, Denver.
that this problem persists while patients Supported by General Clinical Research Centers Program, National Centers for Research are not receiving therapy. tion, a modality that is currently used Submitted for publication May 30, ; revisions received Sept 11,and Nov 10, ; accepted Nov 20, less frequently.
In a similar fashion, Reprint requests: Nina S, bone density in acute leukemia. ago, when patients were more likely to Copyright © by Mosby, Inc. require lengthy hospitalization, bone density in acute leukemia. time since starting maintenance thera- class.
The time spent in the 23 weight- We conducted a cross-sectional study py. The participants were slightly older bearing activities was totaled to yield a of 75 individuals who were in the main- at diagnosis 6. among subjects. therapy for management of chALL.
We measured BMD to determine whether Clinical Assessment Biomarkers this population is at risk for osteopenia A nurse determined Tanner stage, Plasma magnesium, phosphorus, and and osteoporosis. We hypothesized height, weight, and self-reported un- calcium were measured by atomic ab- that decreased BMD is associated with confirmed history of fractures and sorption spectrophotometry Beckman older age at diagnosis and a high-risk avascular necrosis.
Age- race- and Instruments; Brea, Califplasma diagnostic category, shorter elapsed sex-standardized body mass index z hydroxyvitamin D3, 1,dihydroxyvi- time since the beginning of mainte- scores were computed with the tamin D3, osteocalcin, and intact nance therapy, bone density in acute leukemia, low calcium intake, bone density in acute leukemia, and Anthro-Software for Calculating Pe- parathyroid hormone were determined reduced weight-bearing exercise. We diatric Anthropometry US Center by radioimmunoassay DiaSorin; Still- also investigated potential interactions for Disease Control; Atlanta, Ga.
All immunoassays were ing activity. trathecal doses 23 and steroid therapy expressed as prednisone equiva- Data Analysis METHODS lents. Exclusions included 1 sex-specific normative values provid- progressing to the Tanner 2 stage.
Dur- Software. The study protocol was ap- frequency questionnaire measured on BMDA z score varied by calcium proved by the Colorado Multiple Insti- current intake of calcium, phosphorus, intake.
The potential confounding ef- tute Review Board for Clinical magnesium, vitamin D, caffeine, pro- fect of BMI z score and total days hos- Investigators, and informed consent tein, and nutritional supplements. Data were was obtained.
Weight-bearing activity bone density in acute leukemia assessed analyzed with the SAS software pack- Eligible participants and nonpartici- with an unvalidated adaptation of an age Version 6. py, a mean duration of 2. had 2 fractures since being given the di- ceived dexamethasone as part of their In multiple linear regression, BMDA agnosis of ALL. The incidence density treatment regimen. cranial radiation, and total days hospi- for a mean of 7.
No patient had a the relationship between elapsed time therapy. The incidence density of frac- BMDA z score. BMI z score was not The subjects had a mean BMI z tures in subjects with a BMDA z score found to appreciably change the rela- score of 0.
Forty-nine percent of the indi- than those in the normal range 18 vs 8 excluded from the analysis. dergoing maintenance therapy.
A, Scatterplot of time elapsed since beginning maintenance therapy years versus unadjusted whole bone density in acute leukemia BMDA z score ie, raw data. Table II. There was no difference significantly to the association with was also included in the final analysis.
according to sex between subjects in BMDA z score. because of small sample sizes. cording to increased elapsed time since The interaction between sex and Cumulative steroid dosage each for- starting maintenance. The differ- togethersteroid dosage intensity, cu- relationship between weight-bearing ence between individuals in the low mulative methotrexate dosage, metho- physical activity and BMDA. The time elapsed since starting main- The mean weight-bearing score was score.
Although time trends must be tenance was the most important pre- not different among the individuals interpreted with caution because of the dictor of BMDA z score. Every year with a whole body BMDA z score in cross-sectional design, our study elapsed since starting maintenance was the osteopenic range 3.
proves linearly as time elapses after in BMDA z score Figure. Mean diagnosis. Also, Table II reviews the daily intake of values of those in the nonosteopenic these patients have a lower incidence various nutrients derived from the food range.
Bone density in acute leukemia of the biomarkers as of fractures. Although the rate of frac- frequency questionnaire expressed as continuous variables adjusted for age tures was determined by self-report, both absolute amounts and percent of and sex also showed no association with BMD status was not known by the Recommended Dietary Allowance con- whole body BMDA z score.
participant at the time of the survey, sumed. high-normal levels. population of individuals with a histo- with most other reports in the litera- Subjects with an osteopenic whole ry of childhood acute lymphoblastic ture. However, our data may better body BMDA did not differ significantly leukemia would be osteopenic, we represent the experience of future from those with a normal BMD in found that the age- and sex-standard- ALL survivors.
Our results are based terms of current diet except for protein ized BMD was within the normal on a larger sample size than many of and phosphorus intake. Only Nysom et al in- of the nutrients including protein and 0. Past studies were sociation bone density in acute leukemia BMDA z score when the the off-therapy group who were at risk based on subjects who received treat- intakes were examined continuously for low BMD.
ment as early as 20 years ago, when and as categorical variables based on Individuals still receiving mainte- immobility caused by prolonged hospi- quartiles derived from the subjects.
In one study the subjects had differences among subgroups in multi- dexamethasone therapy, a favored been hospitalized a median of variate regression analyses bone density in acute leukemia the ef- drug during maintenance therapy, was days.
In a similar man- was largely caused by the patients who and the bone density in acute leukemia of individual nutrients. yearssuggesting a potential cohort ef- should be made for some measure of Serum and urine bone density in acute leukemia of bone fect. Furthermore, previous studies in- body size for age such as BMI z metabolism markers suggested normal cluded large numbers of patients who score when BMD is evaluated by bone and calcium homeostasis, even in had received cranial radiation.
Gilsanz dual-energy x-ray absorptiometry. individuals with low standardized et al15 observed that reduced BMD However, analyses of our data with BMD. Past studies yielded conflicting was found only in subjects with a histo- and without such an adjustment yield- results, especially in terms of 1,di- ry of cranial radiation.
The proportions ed similar results. hydroxyvitamin D3 activity. nial radiation, consistent with current etary nonsupplement calcium intake Our data support the conclusion that treatment practice.
in leukemia survivors, we found no as- survivors of childhood acute lym- Our data agree with one recent small- sociation with nutrient intake.
Diet in phoblastic leukemia who receive cur- er study. Van Der Sluis et al32 conclud- our subjects was uniformly excellent, rent types of therapy will not have sig- ed that 23 survivors of chALL who had with few individuals displaying subop- nificant long-term abnormalities of received high doses of dexamethasone timal nutrition.
Therefore it may have BMD after therapy is completed. on BMD. Perhaps nutritional factors higher incidence of self-reported frac- Several limitations of our study during the treatment period play a tures. However, no factors were identi- should be discussed. We relied on the larger role in affecting bone accumu- fied that would identify the individuals manufacturer for age- and sex-matched lation than these behaviors after com- most at risk.
Recent data suggest that normative BMD data. The references pletion of therapy, bone density in acute leukemia, which cannot be nutritional supplements and weight- were derived from a largely white pop- assessed by these data.
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Normal bone mineral density after treatment for childhood acute lymphoblastic leukemia diagnosed between and Nina Kadan-Lottick, MD, Julie A. Marshall, PhD, Anna E. Barón, PhD, Nancy F. Krebs, MD, K. Michael Hambidge, MD, and Edythe Albano, MD Acute lymphoblastic leukemia is the Objective: We investigated whether previous reports of reduced bone min- most common pediatric BACKGROUND: Reduced bone mineral density and increased fracture risk have been reported in children with cancer. In this study, we aimed to determine the growth and bone mineral density (BMD) of the children off chemotherapy for acute lymphoblastic leukemia, and the probable risk blogger.com by: 29 Aug 11, · 1. Blood. Aug 11;(6) doi: /blood Epub May Bone mineral density in adult survivors of childhood acute leukemia: impact of hematopoietic stem cell transplantation and other treatment blogger.com by: 60
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