학술논문
Predictors of low and very low bone mineral density in long-term childhood acute lymphoblastic leukemia survivors: Toward personalized risk prediction.
Document Type
Academic Journal
Author
Nadeau G; CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.; Division of Endocrinology, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada.; Samoilenko M; CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.; Fiscaletti M; CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.; Veilleux LN; Montreal Shriners Hospital for Children, Montreal, Quebec, Canada.; Curnier D; CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.; School of Kinesiology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.; Laverdière C; CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.; Division of Hemato-Oncology, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada.; Sinnett D; CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.; Krajinovic M; CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.; Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada.; Lefebvre G; Department of Mathematics, UQAM, Montreal, Quebec, Canada.; Alos N; CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.; Division of Endocrinology, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada.
Source
Publisher: John Wiley Country of Publication: United States NLM ID: 101186624 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1545-5017 (Electronic) Linking ISSN: 15455009 NLM ISO Abbreviation: Pediatr Blood Cancer Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Cohorts of childhood acute lymphoblastic leukemia (cALL) survivors reaching adulthood are increasing. Approximately 30% of survivors meet criteria for low bone mineral density (BMD) 10 years after diagnosis. We investigated risk factors for low BMD in long-term cALL survivors.
Methods: We recruited 245 cALL survivors from the PETALE (Prévenir les effets tardifs des traitements de la leucémie aiguë lymphoblastique chez l'enfant) cohort, who were treated with the Dana Farber Cancer Institute protocols, did not experience disease relapse or hematopoietic stem cell transplants, and presented with more than 5 years of event-free survival. Median time since diagnosis was 15.1 years.
Results: Prevalence of low DXA-derived BMD (Z-score ≤-1) ranged between 21.9% and 25.3%, depending on site (lumbar spine (LS-BMD), femoral neck (FN-BMD), and total body (TB-BMD), and between 3.7% and 5.8% for very low BMD (Z-score ≤-2). Males had a higher prevalence of low BMD than females for all three outcomes (26%-32% vs. 18%-21%), and male sex acted as a significant risk factor for low BMD in all models. Treatment-related factors such as cumulative glucocorticoid (GC) doses and cranial radiation therapy (CRT) were associated with lower BMDs in the full cohort and in females at the FN-BMD site.
Conclusion: Low and very low BMD is more prevalent in male cALL survivors. Male sex, high cumulative GC doses, CRT, risk group, and low body mass index (BMI) were identified as risk factors for low BMD. A longer follow-up of BMD through time in these survivors is needed to establish if low BMD will translate into a higher risk for fragility fractures through adulthood.
(© 2024 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)
Methods: We recruited 245 cALL survivors from the PETALE (Prévenir les effets tardifs des traitements de la leucémie aiguë lymphoblastique chez l'enfant) cohort, who were treated with the Dana Farber Cancer Institute protocols, did not experience disease relapse or hematopoietic stem cell transplants, and presented with more than 5 years of event-free survival. Median time since diagnosis was 15.1 years.
Results: Prevalence of low DXA-derived BMD (Z-score ≤-1) ranged between 21.9% and 25.3%, depending on site (lumbar spine (LS-BMD), femoral neck (FN-BMD), and total body (TB-BMD), and between 3.7% and 5.8% for very low BMD (Z-score ≤-2). Males had a higher prevalence of low BMD than females for all three outcomes (26%-32% vs. 18%-21%), and male sex acted as a significant risk factor for low BMD in all models. Treatment-related factors such as cumulative glucocorticoid (GC) doses and cranial radiation therapy (CRT) were associated with lower BMDs in the full cohort and in females at the FN-BMD site.
Conclusion: Low and very low BMD is more prevalent in male cALL survivors. Male sex, high cumulative GC doses, CRT, risk group, and low body mass index (BMI) were identified as risk factors for low BMD. A longer follow-up of BMD through time in these survivors is needed to establish if low BMD will translate into a higher risk for fragility fractures through adulthood.
(© 2024 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)