The proportion of bone mineral density in children with high risk acute lymphoblastic leukemia after 6- and 12-month chemotherapy maintenance phase

Mira Christiyani Santoso; Endang Windiastuti; Alan R. Tumbelaka

doi:10.14238/pi50.6.2010.365-70

Mira Christiyani Santoso Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Endang Windiastuti Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Alan R. Tumbelaka Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta

DOI: https://doi.org/10.14238/pi50.6.2010.365-70

Keywords: acute lymphoblastic leukemia, osteopenia, osteoporosis, children

Abstract

Background Low bone mineral density (BMD) value is one of the current concerns in acute lymphoblastic leukemia (ALL) patients. Some risk factors including use of chemotherapeutic drugs, nutritional status, phy sical activities, and progression of disease are suspected as the predisposing factors for development of osteopenia and osteoporosis.

Objectives To obtain the proportion of BMD z-score, level of calcium ions, and 25 (OH)D3 in children 'With high risk ALL after 6 and 12 months chemotherapy maintenance phase.

Methods We conducted a cross-sectional comparative study from May 2008 to May 2010. Subjects were high risk ALL patients aged 5-18 years old who had completed the 6 or 12 months chemotherapy maintenance phase. We measured 25 (OH) D3 level, calcium ion level, and BMD using electro chemi-luminescence immunoassay, ion selective electrode, and dual x-ray absorptiometry, respectively.

Results There were 40 subjects who enrolled this study. The incidence of hypocalcemia and vitamin D deficiency were 33/40 and 40/40, respectively. The mean calcium ion levels, 25 (OH)D3 level, and BMD zô€score values in six months groups were 1.1 (0.1 SD) mmol/L, 21.3 (2 SD) ng/L, -0.7 (0.8 SD), respectively, while in the 12 months group, the values were 1.1 (0.0 SD) mmol/L, 21(2.2 SD) ng/L, -1.7 (0.6 SD), respectively (P=0.478). Body mass index (BMI) and corticosteroid cumulative dose is correlated \\lith the low BMD values in L₁-L₄.

Conclusion The bone mineral metabolism disorder marked with the low levels of calcium, 25 (OH)D3 and osteopenia was observed in ALL patients who underwent chemotherapy. The proportion of the BMD z-score value, calcium ion level, and 25 (OH) D3 in the two groups were not statistically significant.

References

1. Halton JM, Atkinson SA, Fraher L, Webber C, Gill GJ, Dawson S, et al. Altered mineral metabolism and bone mass in children during treatment for acute lymphoblastic leukemia.J Bone Miner Res.1996;11:1774-83.
2. Sellin RV, Brosnan P, Delpassand A, Zietz H, Klein MJ. Osteopenia in young adult survivors of childhood cancer. J Pediatr Hematol Oncol. 1999;3:,272-8.
3. Hogler W, Wehl G, Staa \IT, Meister B, Franke AK. Incidence of skeletal complications during treatment of childhood acute lymphoblastic leukemia: comparison of fracture risk 'With the general practice research database. Pediatr Blood Cancer. 2007;48:21-7.
4. Cohn SL, Morgan ER, Mallete LE. The spectrum of metabolic bone disease in lymphoblastic leukemia. Cancer. 2003;59;346-50.
5. Meister B, Gabner I , Streff W, Dengg K , Fink FM. Methotrexate osteopathy in infants 'With tumors of the central nervous system. Med Pediatr Oncol. 1994;23:493-96.
6. Blayer WA. The clinical pharmacology of methotrexate: new application of and old drug. Cancer. 1978;41:36-51.
7. Canalis E. Mechanism of glucocorticoid action in bone: implication to glucocorticoidô€‹induced osteoporosis. J Clin Endocrinol Metab. 1996;81:3441-7.
8. Hartman C , Hochberg Z, Shamir R. Osteoporosis in pediatrics. IMAj. 2003;5:509-15.
9. Steelman J, Zeitler P. Osteoporosis in pediatrics. Pediatr Rev. 2001;22:56-65.
10. Atkinson SA, Halton JM, Bradley C, Wu B, Barr RD. Bone and mineral abnormalities in childhood acute lymphoblastic eukemia: influence of disease, drugs, and nutrition. Int J Cancer Suppl. 1998;11:35-9
11. Strauss Aj, Su JT, Dalton VM, Gelber RD, Sallan SE, Silverman LB. Bone morbidity in children treated for acute lymphoblastic leukemia. j Clin Oncol. 2001;19:3066-72.
12. Ariskoki P, Kroger H, Riikonen P, Parviainen M, Voutilainen R.D isturbance in bone turnover in children with malignancy at completion chemoterapy. Med Pediatr Oneol. 1999;33:455-61.
13. Davies JH, Evans BAJ, Jenney MEM, Gregory]W. Factors influencing bone mineral decrements during treatment of childhood acute lymphoblastic leukemia. Welsh Paediatr J. 2000:24:26-30.
14. Bushinsky AD, Monk RD. Calcium. LanceLI998:352:306-11.
15. Ganong W E Hormonal control of calcium metabolism and the physiology of bone. In: Ganong W F, editor. Review of medical physiology. 17th ed. Connecticut: Appleton and Lange, 1995: p. 352-64.
16. Chesney RW. Metabolic bone disease. In: Behrman RE, Kliegman RM, Jenson HB, Stanton BF, editors. Nelson's textbook of pediatrics.1 8th eel. Pennsylvania: Saunders,2 007; p.2893-8.
17. Holick ME VitaminD deficiency. 81.
18. Kaste SC, Wallace DJ, Rose SR, BoyettJM, Lustig RH, Rivera GK. Bone mineral decrements in survivors of childhood acute lymphoblastic leukemia frequency of occurrence and risk factors for their development. Leukemia. 2001;15:728-34.
19. Zhao LJ,Jiang H,P apasian CJ, Maulik D,D rees B, Hamilton J, et al. Corelation of obesity and osteoporosis: effect of fat mass on the detennination of osteoporosis. J Bone Miner Res. 2008:23:17-29.