No impact of disease and its treatment on bone mineral density in survivors of childhood acute lymphoblastic leukemia

Jain, Silky; Jain, Sandeep; Kapoor, Gauri; Virmani, Anju; Bajpai, Ram

doi:10.1002/pbc.26271

Cited by 14 publications

(29 citation statements)

References 49 publications

(126 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These studies confirmed some of the well‐documented issues in childhood cancer survivors including the previously reported detrimental effects of cranial radiation on neurocognition 10‐13 and neuroendocrine axis, 12 of neck radiation on thyroid function, 8,11 and of alkylating agents on fertility 11,13,25,26 . Contrary to published literature, 29 a single study from India showed that bone mineral density in leukemia survivors was similar to that of controls 23 . This may be explained by the relatively lower doses of methotrexate and steroids as well as that of cranial radiation used in their cohort.…”

Section: Scientific Knowledgesupporting

confidence: 83%

“…A summary of results of 21 studies 8‐28 is tabulated (Supporting Information Table 1) and categorized by organ systems and late effects as used in the Children's Oncology Group Survivorship Guidelines 29 . All except one 8 of these studies have been published in the last decade, highlighting the recent expansion in work in this area in India.…”

Section: Scientific Knowledgementioning

confidence: 99%

“…Also, the bone mineral density was measured at a single cross‐section of more than two years after the cessation of therapy, and absence of longitudinal data limits our inferences. The prevalence of overweight/obesity varied from 1% to 32% and may reflect the heterogeneity in patient selection, methodology, and study design 11,13,20‐24 . For late effects of the heart the duration of follow‐up was not sufficient to conclude on the magnitude of increased risk.…”

Section: Scientific Knowledgementioning

confidence: 99%

See 2 more Smart Citations

Childhood cancer survivorship and late effects: The landscape in India in 2020

Arora

Seth

et al. 2020

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Survivorship care is a major area of focus in the holistic management of childhood cancer with current knowledge and information almost exclusively from high‐income countries. In this review, we summarize the state of scientific knowledge, service delivery, advocacy initiatives, and research efforts in this field in India. Twenty‐one single‐center studies published until today (20 in the last decade) confirm some of the well‐documented issues in childhood cancer survivors and highlight the high prevalence of hepatitis B and hepatitis C infection in our survivors. Heterogeneity in methodology, outcome metrics, and quality precludes drawing further conclusions, and the ongoing multicenter Indian Pediatric Oncology Group study would address this. Besides the usual model of follow‐up clinics in hospital settings, innovative models of service delivery led by not‐for‐profit organizations are being developed. Advocacy initiatives driven by survivors and support groups are also under way. All of these portend a promising future.

show abstract

Section: Scientific Knowledgesupporting

confidence: 83%

Section: Scientific Knowledgementioning

confidence: 99%

Section: Scientific Knowledgementioning

confidence: 99%

See 1 more Smart Citation

Childhood cancer survivorship and late effects: The landscape in India in 2020

Arora

Seth

et al. 2020

Pediatric Blood & Cancer

View full text Add to dashboard Cite

show abstract

“…52 Also, our definition of low BMD is consistent with prior studies by others in survivors. 23,26,27,29,[31][32][33][34][35][36][37][38][39][40]53 An important consideration is the clinical implications of identifying reduced BMD. The COG long-term follow-up guidelines recommend survivors with/at risk of decreased BMD conduct regular weight-bearing activity and ensure adequate vitamin D/calcium intake through diet or supplementation.…”

Section: Discussionmentioning

confidence: 99%

“…26,29,34,35 Low BMD was defined as >1 SD (z-score less than −1) and very low BMD as >2 SDs (z-score less than −2) below age-matched, sex-matched, and race-matched norms, consistent with prior studies in childhood cancer survivors. 13,[36][37][38][39][40]…”

Section: Bmd Evaluationmentioning

confidence: 99%

Severity of reduced bone mineral density and risk of fractures in long‐term survivors of childhood leukemia and lymphoma undergoing guideline‐recommended surveillance for bone health

Bloomhardt

Sint

Ross

et al. 2019

Cancer

View full text Add to dashboard Cite

Background Survivors of childhood leukemia/lymphoma are at increased risk for reduced bone mineral density (BMD). The authors sought to determine the frequency of reduced BMD detected by off‐therapy surveillance, factors associated with reduced BMD, and the association of reduced BMD with fractures. Methods This cross‐sectional study included childhood leukemia/lymphoma survivors attending 2 survivorship clinics who received guideline‐recommended BMD surveillance ≥2 years post‐therapy with dual‐energy x‐ray absorptiometry (from January 1, 2004 to August 31, 2016). Lumbar spine BMD z‐scores were height‐for‐age–adjusted. Low and very low BMD were >1 SD and >2 SDs below norms, respectively. Treatment, chronic conditions, and fractures were abstracted from medical records. Logistic regression was used to examine the association of low BMD with patient/treatment factors and fractures. Results In total, 542 patients (51.5% female) with a mean age of 15.5 years (range, 4.4‐52.2 years) who were 6 years post‐therapy (range, 2.0‐35.1 years) were evaluated, including 116 who reported post‐therapy fractures. Lumbar spine low BMD was identified in 17.2% of survivors, and very low BMD was identified in 3.5% of survivors, but frequencies varied considerably between subgroups; 10.8% of survivors aged 15 to 19 years at diagnosis had very low BMD. In multivariable analyses, older age at diagnosis, white race, and being underweight were significantly associated with low BMD. Survivors with low BMD had greater odds of nondigit fractures (odds ratio, 2.2; 95% CI, 1.3‐3.7) and specifically long‐bone fractures (odds ratio, 2.7; 95% CI, 1.5‐4.7). Conclusions In this study of childhood leukemia/lymphoma survivors undergoing guideline‐recommended dual‐energy x‐ray absorptiometry surveillance, patients who were older at diagnosis, white, and underweight were at the highest risk for lumbar spine low BMD. Low BMD was associated with a greater risk of fractures, emphasizing the clinical importance of surveillance.

show abstract

Vitamin D supplementation for children with cancer: A systematic review and consensus recommendations

et al. 2021

View full text Add to dashboard Cite

Background Prevalent vitamin D deficiency (VDD) and low bone mineral density (BMD) have led to vitamin D supplementation for children with cancer, regardless vitamin D status. However, it remains unsettled whether this enhances bone strength. We sought to address this issue by carrying out a systematic review of the literature. Methods We conducted a literature search using PubMed, Embase, and Cochrane databases. Studies including children up to 5 years after cancer therapy were assessed for the association between 25‐hydroxyvitamin D (25OHD) levels and BMD Z‐scores or fractures, and the effect of vitamin D supplementation on BMD or fractures. Evidence quality was assessed using the GRADE methodology. Results Nineteen studies (16 observational and 3 interventional, mainly involving children with hematologic malignancies) were included. One study which analyzed 25OHD as a threshold variable (≤10 ng/ml) found a significant association between 25OHD levels and BMD Z‐scores, while 25OHD as a continuous variable was not significantly associated with BMD Z‐scores in 14 observational studies. We found neither a significant association between lower 25OHD levels and fractures (2 studies), nor between vitamin D (and calcium) supplementation and BMD or fracture frequency (3 studies) (very low quality evidence). Conclusion There is a lack of evidence for an effect of vitamin D (and calcium) supplementation on BMD or fractures in children with cancer. Further research is needed; until then, we recommend dietary vitamin D/calcium intake in keeping with standard national guidelines, and periodic 25OHD monitoring to detect levels <20 ng/ml. Vitamin D/calcium supplementation is recommended in children with low levels, to maintain levels ≥20 ng/ml year‐long.

show abstract

No impact of disease and its treatment on bone mineral density in survivors of childhood acute lymphoblastic leukemia

Cited by 14 publications

References 49 publications

Childhood cancer survivorship and late effects: The landscape in India in 2020

Childhood cancer survivorship and late effects: The landscape in India in 2020

Severity of reduced bone mineral density and risk of fractures in long‐term survivors of childhood leukemia and lymphoma undergoing guideline‐recommended surveillance for bone health

Vitamin D supplementation for children with cancer: A systematic review and consensus recommendations

Contact Info

Product

Resources

About