Bone mineral density in adult survivors of childhood acute leukemia: impact of hematopoietic stem cell transplantation and other treatment modalities

• Published in: Blood 2011-08, Vol.118 (6), p.1481-1489
• Main Authors: Le Meignen, Marion, Auquier, Pascal, Barlogis, Vincent, Sirvent, Nicolas, Contet, Audrey, Simeoni, Marie-Claude, Galambrun, Claire, Poirée, Marilyne, Chastagner, Pascal, Play, Barbara, Villes, Virginie, Berbis, Julie, Chambost, Hervé, Bordigoni, Pierre, Michel, Gérard
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Acute Disease; Adolescent; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bone Density; Child; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Humans; Leukemia, Myeloid - metabolism; Leukemia, Myeloid - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Linear Models; Male; Medical sciences; Multivariate Analysis; Precursor Cell Lymphoblastic Leukemia-Lymphoma - metabolism; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prednisone - administration & dosage; Prednisone - adverse effects; Prospective Studies; Survivors; Young Adult
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2011-01-332866

Femoral and lumbar bone mineral densities (BMDs) were measured in 159 adults enrolled in the Leucémies de l'Enfant et de l'Adolescent program, a French prospective multicentric cohort of childhood leukemia survivors. BMDs were expressed as Z-scores, and multivariate linear regression analyses were used to construct association models with potential risk factors. Mean age at evaluation and follow-up was 23 and 14.7 years, respectively. In the whole cohort, mean femoral Z-score was −0.19 ± 0.08. Two factors were associated with lower femoral BMD transplantation (−0.49 ± 0.15 vs −0.04 ± 0.10 in the chemotherapy group; P = .006) and female sex (−0.34 ± 0.10 vs −0.03 ± 0.13; P = .03). Among patients who received a transplant, the only significant risk factor was hypogonadism (−0.88 ± 0.16 vs −0.10 ± 0.23; P = .04). A slight reduction in lumbar BMD (mean Z-score, −0.37 ± 0.08) was detected in the whole cohort without difference between the transplantation and chemotherapy groups. Among patients who received a transplant, younger age at transplantation was correlated with a low lumbar BMD (P = .03). We conclude that adults who had received only chemotherapy for childhood leukemia have a slight reduction in their lumbar BMD and a normal femoral BMD. Patients who received a transplant with gonadal deficiency have a reduced femoral BMD which might increase the fracture risk later in life.