Bone morbidity in pediatric acute lymphoblastic leukemia

Abstract

Acute lymphoblastic leukemia (ALL), currently the most common pediatric leukemia, has a high curability rate of up to 90%. Endocrine disorders are highly prevalent in children with ALL, and skeletal morbidity is a major issue induced by multiple factors associated with ALL. Leukemia itself is a predominant risk factor for decreased bone formation, and major bone destruction occurs secondary to chemotherapeutic agents. Glucocorticoids are cornerstone drugs used throughout the course of ALL treatment that exert significant effects on demineralization and osteoclastogenesis. After completion of treatment, ALL survivors are prone to multiple hormone deficiencies that eventually affect bone mineral accrual. Dualenergy X-ray absorptiometry, the most widely used method of measuring bone mineral density, is used to determine the presence of childhood osteoporosis and vertebral fracture. Supplementation with calcium and vitamin D, administration of pyrophosphate analogues, and promotion of mobility and exercise are effective options to prevent further bone resorption and fracture incidence. This review focuses on addressing bone morbidity after pediatric ALL treatment and provides an overview of bone pathology based on skeletal outcomes to increase awareness among pediatric hemato-oncologists and endocrinologists.

Acrophyseal growth arrest in a long-term survivor of acute lymphoblastic leukemia

“…In case of our patient, the ALL and osteotoxic treatment strategy, complicated by severe infections and a prolonged period of 10 months of inactivity, caused significant bone morbidity including severe loss of BMD accompanied with multiple insufficiency fractures and evidence of total lack of height gain at the age of 3 years [2,12]. Our patient did not receive cranial radiation or stem cell therapy, so potential long-term effects on bone of these treatments could be safely ruled out [2,13].…”

Musculoskeletal impairments in children receiving intensive therapy for acute leukemia or undergoing hematopoietic stem cell transplant: A report from the Children's Oncology Group

“…It is well known that treatment for ALL is associated with significant risk for acute and chronic MSK toxicities. 1,2,11 One component of ALL therapy associated with substantial MSK toxicity is steroid exposure. It is possible that finding MSK impairments in those with relapsed ALL is driven by steroid exposure and not specifically by ALL.…”

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“…Considering that race, climate and dietary habits also affect BMD, we found similar results when we compared similar studies from our country. When the factors affecting to BMD are reviewed, Inaba, et al [3] reported that there was statistically significant difference between age, leukemia risk group and BMD at [8,16]. The bone biomarkers such as serum Ca, P, ALP and vitamin D levels were not different among patients and there was no significant difference between bone biomarkers and BMD [9,12].…”