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化疗对儿童急性淋巴细胞白血病幸存者骨矿物质密度的剂量相关影响
Annie D Yamanishi1, Deb Determan1, Dennis J Kuo2
1Department of Pharmacy (ADY, DD), Rady Children's Hospital - San Diego, San Diego, CA.
概括
在小儿急性淋巴细胞白血病 (ALL) 幸存者中,高累积剂量静脉注射甲状腺素 (MTX) 与骨矿物质密度 (BMD) 的降低有关. 这一发现凸显了这些年轻患者潜在的长期骨健康风险.
科学领域:
- 儿科瘤学 儿科瘤学
- 内分泌学 在内分泌学.
- 骨的新陈代谢 骨的新陈代谢
背景情况:
- 骨矿物质密度 (BMD) 降低增加了骨质疏松症和骨质疏松症的风险,影响了长期的骨健康.
- 儿童急性淋巴细胞白血病 (ALL) 幸存者可能因治疗方案而面临骨健康变化.
研究的目的:
- 在儿科ALL幸存者中调查静脉注射甲状腺素 (MTX) 和葡萄糖皮质类药物和骨质量损失的累积剂量之间的联系.
- 在长期随访中评估维生素D水平和骨质量之间的关系.
主要方法:
- 对62名接受DXA扫描的儿科ALL幸存者的回顾性分析.
- 累计IVMTX剂量的分类,分为低/中等 (<20,000 mg/m2) 和高 (≥20,000 mg/m2) 组.
- 统计分析包括描述性统计,学生的t测试和线性回归.
主要成果:
- 与服用较低剂量的患者相比,接受高累积IVMTX剂量的患者表现出明显较低的腰椎骨质量 (z-score: -0.86) (z-score: -0.14; p=0.008).
- 在累积葡萄糖皮质激素剂量或维生素D度和骨硬化之间没有发现显著的关联.
- 治疗后DXA扫描的中位时间为2.3年.
结论:
- 在ALL治疗期间,累计IVMTX剂量≥20,000 mg/m2与儿科幸存者的骨矿物质密度下降有关.
- 这表明需要在所有暴露于更高MTX剂量的幸存者中监测骨健康.
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