Bone and mineral abnormalities in childhood acute lymphoblastic leukemia: Influence of disease, drugs and nutrition

Atkinson, Stephanie A.; Halton, Jacqueline; Bradley, Cristine L.; Wu, Binky; Barr, Ronald D.

doi:10.1002/(sici)1097-0215(1998)78:11+<35::aid-ijc11>3.0.co;2-i

Cited by 141 publications

(110 citation statements)

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“…35 During treatment and even without the use of cranial irradiation as part of their treatment (prophylactic treatment of the central nervous system), a significant reduction in BMD was found in these patients in comparison with baseline values. 6,7,9,11,12 There are several cross-sectional studies in which BMD status has been assessed in long-term survivors of childhood ALL. Studies on patients who were treated with cranial irradiation have shown significantly reduced BMD in TB as well as in LS, even Ͼ8 years after completion of treatment.…”

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confidence: 99%

“…1,2 Children with ALL have reduced bone formation [3][4][5][6][7][8][9][10] and bone mineral density (BMD) 3,9,10 at diagnosis. Several studies have demonstrated a BMD decrease during therapy.…”

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confidence: 99%

“…Several studies have demonstrated a BMD decrease during therapy. [6][7][8][9][10][11][12] Cytotoxic agents and steroids have been said to affect normal bone mass accumulation and bone turnover, leading to increased risk for osteoporosis and fractures. 5,13 Although studies have consistently shown that BMD is reduced in patients after the cure of ALL using cranial irradiation during childhood, [14][15][16][17][18][19][20][21][22] few studies have investigated whether these abnormalities persist after completion of therapy in patients who are treated for ALL without the use of cranial irradiation.…”

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confidence: 99%

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Improvement in Bone Mineral Density and Body Composition in Survivors of Childhood Acute Lymphoblastic Leukemia: A 1-Year Prospective Study

Marinovic

Dorgeret²,

Lescoeur³

et al. 2005

Pediatrics

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ABSTRACT. Objectives. Abnormalities in bone mineral density (BMD), body composition, and bone metabolism have been reported in children who were treated for acute lymphoblastic leukemia (ALL) during and after completion of therapy. However, these studies are crosssectional, and no longitudinal data are available in a large group of patients after completion of therapy. In the present study, 1-year longitudinal changes in BMD, body composition, and bone metabolism were evaluated in children with ALL during the first 3 years after completion of therapy without cranial irradiation.Methods. BMD of total body (TB; g/cm 2 ), areal and apparent volumetric lumbar spine (L2-L4), lean body mass, and percentage of body fat were measured by dual-energy x-ray absorptiometry in 37 children (median age: 7.9 years; range: 4.7-20.6 years) who were treated for ALL at a median age of 3.3 years (range: 1.1-16.6 years), after a median time of 2.2 years after the completion of treatment, and after a 1-year follow-up period. Two control subjects (n ‫؍‬ 74) who were matched for gender, age, and pubertal stage were also longitudinally investigated for body composition for 1 year. Usual serum biochemical markers of calcium metabolism and bone turnover were measured in patients during the study period.Results. A slight decrease in TB BMD was found after a median time of 2.2 years after the completion of therapy for ALL in childhood. Patients showed a significantly lower median TB BMD when evaluated <1.5 years as compared with those at >1.5 years since completion of therapy. At the time of first evaluation, the percentage of body fat mass was significantly higher and patients were physically less active than their matched control subjects. Although, as expected, during the 1 year of follow-up both groups showed an annual increment in their BMD measurements, a significantly higher increase in TB BMD was observed in patients in comparison with control subjects. During this same period, the increase in the percentage of body fat mass was slightly lower in ALL patients as compared with control subjects. At the end of the follow-up year, BMD, body-composition parameters, and physical activity of ALL patients were similar to those observed in matched control subjects. Serum biochemical markers of bone turnover were normal at both evaluations.Conclusions. A significant increase in TB BMD and a tendency to a lesser increase in percentage of body fat mass were observed during the study period in ALL patients as compared with chronological age-, gender-, and pubertal stage-matched control subjects. These findings suggest a positive effect of long-term completion therapy and increase in physical activity on BMD, body composition, and bone metabolism in patients who have been treated for ALL. A cute lymphoblastic leukemia (ALL) is the most common childhood malignancy, and 80% of children with standard-risk disease can now expect to be cured. 1,2 Children with ALL have reduced bone formation 3-10 and bone mineral density (BMD) 3,9,10 at diagnosis. Seve...

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Improvement in Bone Mineral Density and Body Composition in Survivors of Childhood Acute Lymphoblastic Leukemia: A 1-Year Prospective Study

Marinovic

Dorgeret²,

Lescoeur³

et al. 2005

Pediatrics

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“…1 Severe osteogenic sideeffects of ALL treatment include osteonecrosis [2][3][4][5][6][7][8][9][10][11] and bone mineral density (BMD) loss, [12][13][14][15][16][17] which often occur during and shortly after antileukemic treatment. Both side effects may lead to adverse events, such as pain, fractures and consequent movement disability.…”

Section: Introductionmentioning

confidence: 99%

Aggravated bone density decline following symptomatic osteonecrosis in children with acute lymphoblastic leukemia

den¹,

Pluijm²,

Fiocco³

et al. 2015

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ABSTRACTmay influence each other's development during treatment for pediatric ALL. Methods Study populationThis study is based on a subset of a previously described cohort. The children (4-18 years old) had newly diagnosed ALL and were treated in The Netherlands according to the Dutch Childhood Oncology Group (DCOG) -ALL9 protocol between January 1997 and November 2004.17,26 As previously described, patients were stratified into a non-high-risk treatment group and a high-risk group. 26 Briefly, high-risk criteria were: white blood cell count higher than 50×10 9

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“…Low levels of bone alkaline phosphatase throughout treatment for acute lymphoblastic leukemia have been described, suggesting impaired osteoblast differentiation (8,16). Prolonged bedrest, poor nutrition, alterations in vitamin D metabolism, growth hormone deficiency, gonadal failure, and changes in insulin-like growth factors and their binding proteins might also influence bone mineralization in children with malignancies (1,11,17).…”

Section: Introductionmentioning

confidence: 99%

Reduced Bone Mineralization in Adolescent Survivors of Malignant Bone Tumors: Comparison of Quantitative Ultrasound and Dual-Energy X-Ray Absorptiometry

Azcona

Burghard

Ruza

et al. 2003

Journal of Pediatric Hematology/Oncology

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Purpose: To assess bone mineralization in adolescents with bone tumors at remission using quantitative digital ultrasound (QUS) and dual-energy x-ray absorptiometry (DEXA), and to compare the bone mineralization values obtained by both methods. Methods:Patients studied were 36 adolescents (21 boys, 15 girls) who had completed treatment of a bone tumor at the University Hospital of the University of Navarra (Pamplona, Spain). QUS was performed at the distal metaphysis of the proximal phalanxes of the last four fingers of the nondominant hand. A DBM Sonic 1200 Ultrasound densitometer was used. DEXA measurements were made at the lumbar spine (vertebrae L1-L4) using the Hologic QDR 4500 W device. Calcium and vitamin D daily intake and grade of physical activity were recorded.Results: Mean age at bone mineralization determination was 19.11 years. Disease-free survival was 4.97 years. Decreased bone mineralization was observed by both methods. Bone mineralization absolute values measured by QUS and DEXA were significantly correlated. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of QUS for predicting osteopenia were 36.4%, 80.0%, 66.7%, 44.4%, and 74.1%, respectively. Daily vitamin D intake was below the recommended dietary allowances.Conclusions: Adolescents in remission from bone tumors have low bone mineralization determined by DEXA or QUS.

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Bone and mineral abnormalities in childhood acute lymphoblastic leukemia: Influence of disease, drugs and nutrition

Cited by 141 publications

References 11 publications

Improvement in Bone Mineral Density and Body Composition in Survivors of Childhood Acute Lymphoblastic Leukemia: A 1-Year Prospective Study

Improvement in Bone Mineral Density and Body Composition in Survivors of Childhood Acute Lymphoblastic Leukemia: A 1-Year Prospective Study

Aggravated bone density decline following symptomatic osteonecrosis in children with acute lymphoblastic leukemia

Reduced Bone Mineralization in Adolescent Survivors of Malignant Bone Tumors: Comparison of Quantitative Ultrasound and Dual-Energy X-Ray Absorptiometry

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