Bone Mineral Density Corrected for Size in Childhood Leukaemia Survivors Treated with Haematopoietic Stem Cell Transplantation and Total Body Irradiation

Abstract

Background: Childhood leukaemia survivors treated with haematopoietic stem cell transplantation and total body irradiation (HSCT-TBI) have multiple risk factors for reduced bone mineral density (BMD) and growth failure; hence, BMD assessment must take body size into consideration. This study aimed to evaluate size-corrected BMD in leukaemia survivors treated with and without HSCT-TBI. Methods: Childhood leukaemia survivors treated with HSCT-TBI (n = 35), aged 17.3 (10.5–20.9) years, were compared with those treated with chemotherapy only, (n = 16) aged 18.5 (16.1–20.9) years, and population references. Outcome measures included anthropometric measurements and BMD by dual-energy X-ray absorptiometry. BMD was corrected for size as bone mineral apparent density (BMAD). Statistical analysis was performed by 1- and 2-sample t tests as well as regression analysis (5% significance). Results: HSCT-TBI survivors were lighter and shorter with reduced spinal heights compared with chemotherapy-only subjects and population references. Compared with population references, HSCT-TBI survivors showed lower BMD standard deviation scores (SDS) (p = 0.008), but no difference in BMAD-SDS, and chemotherapy-only survivors showed no differences in neither BMD-SDS nor BMAD-SDS. All HSCT-TBI participants with BMD-SDS <–2 had BMAD-SDS >–2. BMAD-SDS was negatively associated with age (r = –0.38, p = 0.029) in HSCT-TBI survivors. Conclusions: Size-corrected BMD are normal in HSCT-TBI survivors in young adulthood, but may reduce overtime. BMD measurements should be corrected for size in these patients to be clinically meaningful.

Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: evidence-based recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group

“…CAYA cancer survivors are at increased risk of low BMD (moderate-quality evidence), 6,7,[9][10][11] very low BMD (moderate-quality evidence), 6,7,9,10,[30][31][32][33][34][35][36][37][39][40][41][42][43][44][47][48][49][50][51][52][53][54][55][58][59][60][61][62]64,[66][67][68][69][70][71] and lower BMD Z-scores (moderatequality evidence) after a follow-up period ranging from 2•7 to 27•2 years. 30,31,33,38,39,41,43,<...…”

“…density surveillance? Risk and risk factors for low BMD, very low BMD, lower BMD Z-score, and fractures in CAYA cancer survivors diagnosed up to 25 years of age Very low BMD (Z-score ≤10,[30][31][32][33][34][35][36][37][39][40][41][42][43][44][47][48][49][50][51][52][53][54][55][58][59][60][61][62]64,[66][67][68][69][70][71] …”

Gamma-Tocotrienol Protects the Intestine from Radiation Potentially by Accelerating Mesenchymal Immune Cell Recovery

“…TBI is used to treat hematopoietic malignancies and solid tumors. Further, TBI and chemotherapeutic drugs are routinely used to prepare patients for hematopoietic stem cell transplants [25,26,27,28,29]. In addition, astronauts are continuously exposed to chronic doses of TBI during their entire period of a space mission.…”