Skeletal, neuromuscular and fitness impairments among children with newly diagnosed acute lymphoblastic leukemia

Abstract

This study describes skeletal, neuromuscular and fitness impairments among 109 children (median age 10 (range 4–18) years, 65.1% male, 63.3% white) with acute lymphoblastic leukemia (ALL), enrolled on a physical activity trial from 2009 to 2013. Outcomes were measured 7-10 days after diagnosis and compared to age- and sex-specific expected values. Associations between function and HRQL were evaluated with logistic regression. Children low values for BMD z-scores/height (mean±standard error: −0.53±0.16 vs. 0.00±0.14, p <0.01), body mass index percentile (57.6±3.15 vs. 50.0±3.27%, p=0.02), quadriceps strength (201.9±8.3 vs. 236.1±5.4 Newtons, p<0.01), six minute walk distance (385.0±13.1 vs. 628.2±7.1 meters, p < 0.001), and Bruininks-Oseretsky Test of Motor Proficiency (23±2.5 vs. 50±3.4%, p < 0.001). Quadriceps weakness was associated with a 20.9-fold (95% CI 2.5–173.3) increase in poor physical HRQL. Children with newly diagnosed ALL have weakness and poor endurance and may benefit from early rehabilitation that includes strengthening and aerobic conditioning.

Modifying bone mineral density, physical function, and quality of life in children with acute lymphoblastic leukemia

“…Unlike previous reports, however, neither study group demonstrated vertebral fractures. To what extent our population's slightly higher than expected BMI values (compared to normative data) may have been protective against fractures warrants further study.…”

“…Each year, more than 3,000 new cases of childhood acute lymphoblastic leukemia (ALL) are diagnosed in the United States . At diagnosis, children experience motor problems, suggesting that the cancer itself results in functional impairment . Thirty‐six percent of children with ALL reported musculoskeletal pain at diagnosis; as early as 3 days after vincristine administration, areflexia, weakness and atrophy of the extremities, muscle pain/cramps, and decreased range of motion are noted .…”

Effect of Low-Magnitude, High-Frequency Mechanical Stimulation on BMD Among Young Childhood Cancer Survivors

“…For children diagnosed with cancer, the cumulative effects of disease, 1,2 chemotherapy, 3 radiation exposure, 4 physical inactivity, 5 and poor nutrition 6 are detrimental to bone mineralization and may result in sub-optimal BMD that persists into adulthood. 7,8 The percentage of childhood cancer survivors with low BMD is reported as high as 47%, depending on tumor type and treatment exposure.…”

Screening and management of adverse endocrine outcomes in adult survivors of childhood and adolescent cancer

“…39,40 Treatment-related weakness and poor aerobic conditioning might also be contributory. 41,42 Among survivors of craniopharyngioma, hypothalamic obesity has long been a reported sequela of surgery and radiation; these survivors might also become hyperphagic. 43 Survivors with a history of cranial radiotherapy or brain surgery should have periodic assessments of height, weight, BMI, and HbA 1c or fasting blood glucose.…”