Bone mineral status at diagnosis οf children with hematologic malignancy

Reduced bone mineral density (BMD) has been reported during and after treatment of children with hematologic malignancies. However, little is known about the skeletal status of these patients at diagnosis. The aim of this study was to evaluate the skeletal profile of newly diagnosed pediatric patients with Acute lymphoblastic leukemia (ALL), Hodgkin Lymphoma (HL), and Non-Hodgkin Lymphoma (NHL). A case-control study included 50 children with ALL, 11 with HL, and 10 with NHL and compared them to 108 sex- and age-matched controls. Patients underwent bone metabolism evaluation and dual-energy X-ray absorptiometry (DXA) scan at the time of diagnosis. Seventy-one children were evaluated (43 boys) with a median age of 8.25 years (2.16-17.33 years). Twenty-one with ALL had bone pain (16 with a limp pain) at diagnosis. More than half (59.1%) of the patients were vitamin D sufficient (25-ΟΗ-D > 20 ng/ml). Patients had lower values of serum procollagen type I C-terminal propeptide (PICP), osteocalcin (OC), and tartrate-resistant acid phosphatase (bTRAP5b) (p < 0.001) than controls. A DXA scan was performed in 45 patients. Patients with ALL and Lymphoma had lower values of Lumbar Spine (L1-L4, LS) BMD Z-score (p < 0.001, p < 0.01, respectively) while those with ALL had lower values of Total Body Less Head (ΤBLH) BMD Z-score (p = 0.003) than controls. Skeletal health is adversely affected in pediatric patients with ALL and Lymphoma at diagnosis. These observations support bone health surveillance in cancer patients and timely intervention starting at the time of diagnosis.