Normal bone mineral density after treatment for childhood acute lymphoblastic leukemia diagnosed between 1991 and
N Kadan-Lottick1, J A Marshall, A E Barón
1Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA.
Insights
Recent childhood acute lymphoblastic leukemia (chALL) survivors show normal bone mineral density (BMD). This suggests that modern chALL treatments do not lead to persistent BMD abnormalities after therapy completion.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Bone Metabolism
Background:
- Previous studies indicated reduced bone mineral density (BMD) in childhood acute lymphoblastic leukemia (chALL) survivors.
- Concerns existed regarding long-term bone health following chALL treatment, potentially linked to intensive therapies like cranial radiation and prolonged hospitalizations.
Purpose of the Study:
- To evaluate bone mineral density (BMD) in a contemporary cohort of patients treated for childhood acute lymphoblastic leukemia (chALL).
- To determine if recent treatment protocols for chALL result in persistent bone density deficits.
Main Methods:
- A cross-sectional study involving 75 chALL survivors diagnosed between 1991-1997.
- Bone mineral density (BMD) assessed using whole-body areal bone mineral densitometry (BMD(A)) expressed as z scores.
- Data collected on diet, physical activity, treatment history, and time since diagnosis.
Main Results:
- The mean whole-body BMD(A) z score was normal (+0.22 +/- 0.96) in the cohort.
- Bone mineral density (BMD) showed a positive association with the time elapsed since maintenance therapy initiation.
- No significant associations were found between BMD and risk status, age at diagnosis, nutrient intake, chemotherapy dosage, or weight-bearing activity.
Conclusions:
- Contrary to earlier findings, this study indicates that current management of chALL does not lead to persistent bone mineral density (BMD) abnormalities.
- Improvements in treatment protocols, possibly reducing reliance on cranial radiation and lengthy hospitalizations, may explain the normalized BMD in recently treated survivors.
Objective:
We investigated whether previous reports of reduced bone mineral density after management for childhood acute lymphoblastic leukemia (chALL) were confirmed in a more recently treated cohort.
Study Design:
In a cross-sectional study 75 subjects who were given the diagnosis of chALL between January 1, 1991, and December 31, 1997 (69% standard, 31% high risk), at Denver Children's Hospital and who were 11 to 82 months post-diagnosis with no history of relapse, secondary malignancy, or transplant underwent whole body areal bone mineral densitometry (BMD(A) expressed as age- and sex-standardized z scores), a food frequency questionnaire, and a weight-bearing activity survey.
Results:
Overall, the mean whole body BMD(A) z score was normal (+0.22 +/- 0.96). A significant positive association was found with whole body BMD(A) z score and years elapsed since the beginning of maintenance (linear regression coefficient = +0.2 Deltaz score/year; 95% CI = 0.09 to 0.3) after adjustment was done for risk status/age category, history of cranial radiation, and total days hospitalized. No association was found with high risk/older age at diagnosis, nutrient intake, chemotherapy dosage, or weight-bearing activity.
Conclusion:
Contrary to previous reports in which cranial radiation and longer hospitalizations were prominent components of therapy, our study suggests that more recently treated patients with chALL do not have persistent abnormalities of bone mineral density after completion of therapy.
