Long-Term Effects on Bone Mineral Density of Different Therapeutic Schemes for Acute Lymphoblastic Leukemia or Non-Hodgkin Lymphoma during Childhood

Abstract

Background: Little is known regarding long-term bone deficit in relationship with the modalities of cancer therapy among survivors of childhood malignancy. Methods: Bone mineral density (BMD) was evaluated at lumbar spine (LS), total hip and femoral neck in 89 patients (44 men) more than 5 years after remission of childhood acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma (NHL). The patients had received chemotherapy (group I; n = 41), chemotherapy and cranial irradiation (group II; n = 32), or bone marrow transplantation (BMT) with total body irradiation (TBI) (group III; n = 16). All patients had received methylprednisolone and 47 additional dexamethasone treatment. Results: A reduced BMD at any site was observed in 44 of the 89 patients, more frequently in men (66%) than women (33%) (p < 0.001). In comparison with group I, mean BMD was significantly lower at all sites in group II and at the total hip and femoral neck in group III. A multivariate analysis showed independent significant influences of male gender at LS (p < 0.001) and of type of treatment and dexamethasone at the hip (p < 0.05). Conclusions: A low bone mass is frequently observed in adult survivors of childhood ALL and NHL, and is associated with male gender at the LS and with dexamethasone treatment, cranial irradiation and BMT/TBI at the hip.

TBI during BM and SCT: review of the past, discussion of the present and consideration of future directions

“…These can include cataract formation in 30-40% (80-90% of those receiving a single fraction of 8-10 Gy), 20,45 gonadal failure, 46 thyroid dysfunction, kidney dysfunction 47,48 and decreased bone mineral density. 49 Survivors are at known risk for chronic oral and dental complications after TBI, with xerostomia being reported by patients as having a major impact on quality of life 1 year after BMT. 50 In a recent analysis of late effects and quality of life of childhood cancer survivors, TBI was strongly associated with short stature and endocrine dysfunction.…”

Are Survivors of Childhood Acute Lymphoblastic Leukemia at Increased Risk for Low Bone Mass?

“…As an increasing number of cancer survivors reaches adulthood, there may be consequences of the treatment, including adiposity, metabolic syndrome traits [2][3][4][5][6][7][8][9] and occasionally low bone mass [10][11][12][13][14][15][16][17][18], which is a condition not totally understood, so far.…”

“…Several pediatric conditions may have an increased risk for low bone mass, which is attributed to the disease itself, genetic characteristics, intensive therapy against the disease [10][11][12][13][14][15][16][17][18][19], as well as body composition modifications [20]. Cancer survivors, particularly ALL patients, are part of one of these important groups and there are several important concerns regarding their bone heath [10][11][12][13][14][15][16][17][18][19].…”

“…Cancer survivors, particularly ALL patients, are part of one of these important groups and there are several important concerns regarding their bone heath [10][11][12][13][14][15][16][17][18][19]. Low bone mass has been observed in all phases of the disease: at diagnosis, during treatment, and throughout the post-treatment period for as long as 20 years [21].…”

“…Throughout chemotherapy, Avascular Necrosis (AVN) is a disabling complication in children and adolescents, especially secondary to steroids [23]. During therapy and many years after its withdrawal, low bone mass may be a consequence of therapy/disease; however, the degree of the decline of bone mass and its recovery are not well elucidated yet [10][11][12][13][14][15][16][17][18]21]. This paper discusses the difficulties of assessing and interpreting bone mass in children and adolescents, the limitations on this assessment in ALL young survivors, the particularities of survivors of hematopoietic Stem Cell Transplantation (SCT), the possible reasons of low bone mass in this group of cancer survivors, as well as some therapeutic issues.…”