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Predictors of bony morbidity in children with acute lymphoblastic leukemia
Author(s) -
Rayar Meera S.,
Nayiager Trishana,
Webber Colin E.,
Barr Ronald D.,
Athale Uma H.
Publication year - 2011
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24040
Subject(s) - medicine , osteopenia , osteoporosis , bone mineral , pediatrics , standard score , population , environmental health , machine learning , computer science
Background To evaluate the relationship between lumbar spine (LS) bone mineral density (BMD) and patient‐, disease‐, and therapy‐related variables, and to define the risk‐factors for fractures in children receiving therapy on Dana‐Farber Cancer Institute acute lymphoblastic leukemia (ALL) protocols. Methods Children (≤18 years) diagnosed with ALL during the period 1995–2006, who are in first clinical remission, were included (n = 124). Dual‐energy X‐ray absorptiometry provided LS‐BMD at diagnosis (n = 46) and during continuation therapy. LS‐BMD was expressed as Z scores based on local population norms. Regression analyses evaluated the risk of osteopenia ( Z ‐score −1.01 to −1.99, osteoporosis ( Z ‐score −2.00 or less) and fractures. Results At diagnosis, 14 0f 46 (30%) patients had osteopenia and 5 (11%) had osteoporosis; whereas, during continuation therapy, 47 of 124 (39.5%) patients had osteopenia, and 10 (8%) had osteoporosis. LS‐BMD at diagnosis had a positive linear relationship with LS‐BMD during continuation therapy (Pearson correlation coefficient 0.619, P < 0.0001). Multivariable analyses identified age ≥10 years and LS‐BMD at diagnosis as independent predictors of LS‐BMD during continuation therapy. Twenty‐three (18.5%) patients developed fractures. Dexamethasone therapy (OR 3.4, 95% CI 1.31, 7.52, P = 0.01) and lower LS‐BMD during the continuation therapy (OR 1.8, 95% CI 1.2, 2.8, P = 0.01) were independent predictors of fracture. Conclusions Older age and lower LS‐BMD at diagnosis are predictors of lower LS‐BMD during continuation therapy. Dexamethasone and lower LS‐BMD during continuation therapy are associated with fractures. Using these variables it is feasible to develop a predictor model to define the risk of bony morbidity in children receiving ALL therapy. Pediatr Blood Cancer 2012; 59: 77–82. © 2011 Wiley Periodicals, Inc.