Abstract
We assessed the clinical and treatment factors that predispose survivors of childhood acute lymphoblastic leukemia (ALL) to low bone mineral density (BMD). Using quantitative computed tomography, we determined the frequency of low BMD (defined as >1.645 standard deviations (SD) below the mean) in leukemia survivors treated with multiagent chemotherapy including prednisone and antimetabolite. All participants had completed therapy at least 4 years earlier, remained in continuous complete remission, and had no second malignancies. We statistically correlated BMD results with patient characteristics and treatment histories. Among 141 survivors (median age, 15.9 years; median time after diagnosis, 11.5 years), median BMD z score was −0.78 SD (range, −3.23 to 3.61 SDs). Thirty participants (21%; 95% confidence interval, 15% to 29%) had abnormally low BMD, a proportion significantly (P < 0.0001) greater than the expected 5% in normal populations. Risk factors for BMD decrements included male sex (P = 0.038), Caucasian race (P < 0.0001), and cranial irradiation (P = 0.0087). BMD inversely correlated with cranial irradiation dose. BMD z scores of patients who received higher doses of antimetabolites were lower than those of other patients. Childhood ALL survivors are at risk to have low BMD, especially males, Caucasians, and those who received cranial irradiation.
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Acknowledgements
We thank Ms Sherri Patterson and Margie Zacher for medical record reviews and data entry, Drs Russell Chesney and Laura Carbone for advice on study design and data interpretation, Ms Myra Hazard for patient recruitment, and Dr Julia Cay for editorial advice and manuscript preparation. This work was supported in part by grants P30 CA-21765 and P01 CA-23099 from the National Cancer Institute, by the American Lebanese Syrian Associated Charities (ALSAC), by the Society for Pediatric Radiology and by a Center of Excellence Grant from the State of Tennessee.
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Kaste, S., Jones-Wallace, D., Rose, S. et al. Bone mineral decrements in survivors of childhood acute lymphoblastic leukemia: frequency of occurrence and risk factors for their development. Leukemia 15, 728–734 (2001). https://doi.org/10.1038/sj.leu.2402078
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DOI: https://doi.org/10.1038/sj.leu.2402078
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