Predictors of low and very low bone mineral density in long-term childhood acute lymphoblastic leukemia survivors:...

Area of Science:

• Pediatric Oncology
• Endocrinology
• Radiology

Background:

• Childhood acute lymphoblastic leukemia (cALL) survivors are increasingly reaching adulthood.
• A significant proportion (30%) experience low bone mineral density (BMD) a decade post-diagnosis.
• Identifying risk factors for low BMD in this population is crucial for long-term health management.

Purpose of the Study:

• To investigate the prevalence and risk factors for low bone mineral density (BMD) in long-term survivors of childhood acute lymphoblastic leukemia (cALL).

Main Methods:

• Analysis of 245 cALL survivors from the PETALE cohort, treated with Dana Farber Cancer Institute protocols.
• Exclusion of patients with disease relapse or hematopoietic stem cell transplants, and those with less than 5 years of event-free survival.
• Assessment of BMD using dual-energy X-ray absorptiometry (DXA) with a median follow-up of 15.1 years since diagnosis.

Main Results:

• Low BMD (Z-score ≤-1) prevalence ranged from 21.9% to 25.3% across different skeletal sites.
• Males exhibited a higher prevalence of low BMD (26%-32%) compared to females (18%-21%).
• Cumulative glucocorticoid doses and cranial radiation therapy were associated with reduced BMD, particularly in females.

Conclusions:

• Low and very low BMD is more common in male cALL survivors.
• Identified risk factors include male sex, high cumulative glucocorticoid doses, cranial radiation therapy, risk group, and low body mass index.
• Further long-term follow-up is necessary to determine if low BMD correlates with increased fracture risk in adulthood.