Adult Haematology
Contributions
Type: Publication Only
Background
Bone health and the loss of bone density are important clinical concerns for patients with cancer who may be at risk for primary osteoporosis because of aging and other risk factors . They may have the added risk for cancer treatment-induced bone loss (CTIBL), which also could be termed secondary osteoporosis related to therapy and cancer as in acute lymphoblastic leukemia (ALL).
Aims
To assess bone mineral density in young adult patients with ALL at presentation and after induction therapy, to determine whether disease and/or chemotherapy can affect bone density
Methods
25 Adult patients aged 20-45 years, with newly diagnosed ALL, presenting to Ain Shams University hospitals were recruited to this cross-sectional prospective study if they were eligible for induction therapy.All patients were evaluated according to published international guidelines for assessment of new acute leukemia patients. In addition, bone mineral density (BMD) was evaluated by using dual-energy X-ray absorptiometry (DXA) for all studied subjects at presentation and at D28 for evaluable patients. Measurements were performed at the lumbar spine (L2 to L4) and the left femoral neck using a Lunar DPX-L scanner. Bone mineral density was expressed in grams per square centimeter (g/cm2). Lumbar spine and femoral neck BMD was evaluated in all patients at diagnosis and after receiving induction chemotherapy. T-score was used to describe BMD (normal, osteopenia or osteoporosis) according to WHO classification .All patients except those who had mature B cell ALL received induction according to Holtzer protocol, while Patient with mature B-cell ALL received hyperCVAD chemotherapy (cycle A).
Results
25 patients with newly diagnosis of ALL were recruited into this prospective study. Mean age was 30.32 (20-45 years), male: female ratio was 3:2. Presenting features include anemia (80%), bleeding tendency (52%), fever (52%) and hyperleucocytosis (32%). Extra medullary infiltration was detected in 3 patients, testis (n=1) and Central nervous system (n= 2).Sixteen patients (64%) had Pre-B ALL, one patient (4%) had Pro-B ALL, two patients (8%) had mature B ALL and six patients (24%) had T ALL. Clonal chromosomal abnormalities was detected in 4 patients (complex chromosomal abnormalities in one patient and t (9; 22) in 3 patients). 21 were evaluable at day +28. Seventeen patients (68%) were in complete remission and four patients (16%) had refractor leukemia.None of the patients had osteoporosis either in the pre or post treatment evaluation (T-score < -2.5). Seven patient (28%) fulfilled the WHO criteria for osteopenia in the lumbar spine at diagnosis (T- score -1 to -2.5). At post-treatment evaluation, ten patients (40%) were found to have osteopenia as assessed at the lumbar spine. Yet the difference in bone density at the lumbar spine did not reach statistical significance (p-value >0.05). There was statistically significant reduction in the BMD at the left femoral neck, in the post treatment evaluation as compared to the pre treatment evaluation, with p-value <0.001.We have tried to correlate the bone density (BMD,T score, Z score) in femoral neck to several clinical variables in a multivariate analysis (age, sex, extra medullary disease, and Ph chromosome). However, we did not find any statistically significant correlation with any of the previous factors.
Summary
Skeletal morbidity, characterized by bone pain, osteonecrosis, fractures, loss of mobility, bone deformation, or osteopenia, is frequently encountered in patients affected by ALL. Clinically important sites for evaluation of osteopenia/ osteoporosis in adult are the lumbar spine (L2-L4), and femoral neck. Larger sized studies are required to draw more firm conclusions and to design screening and prophylactic programs.
Keyword(s): Acute lymphoblastic leukemia, Bone Density
Type: Publication Only
Background
Bone health and the loss of bone density are important clinical concerns for patients with cancer who may be at risk for primary osteoporosis because of aging and other risk factors . They may have the added risk for cancer treatment-induced bone loss (CTIBL), which also could be termed secondary osteoporosis related to therapy and cancer as in acute lymphoblastic leukemia (ALL).
Aims
To assess bone mineral density in young adult patients with ALL at presentation and after induction therapy, to determine whether disease and/or chemotherapy can affect bone density
Methods
25 Adult patients aged 20-45 years, with newly diagnosed ALL, presenting to Ain Shams University hospitals were recruited to this cross-sectional prospective study if they were eligible for induction therapy.All patients were evaluated according to published international guidelines for assessment of new acute leukemia patients. In addition, bone mineral density (BMD) was evaluated by using dual-energy X-ray absorptiometry (DXA) for all studied subjects at presentation and at D28 for evaluable patients. Measurements were performed at the lumbar spine (L2 to L4) and the left femoral neck using a Lunar DPX-L scanner. Bone mineral density was expressed in grams per square centimeter (g/cm2). Lumbar spine and femoral neck BMD was evaluated in all patients at diagnosis and after receiving induction chemotherapy. T-score was used to describe BMD (normal, osteopenia or osteoporosis) according to WHO classification .All patients except those who had mature B cell ALL received induction according to Holtzer protocol, while Patient with mature B-cell ALL received hyperCVAD chemotherapy (cycle A).
Results
25 patients with newly diagnosis of ALL were recruited into this prospective study. Mean age was 30.32 (20-45 years), male: female ratio was 3:2. Presenting features include anemia (80%), bleeding tendency (52%), fever (52%) and hyperleucocytosis (32%). Extra medullary infiltration was detected in 3 patients, testis (n=1) and Central nervous system (n= 2).Sixteen patients (64%) had Pre-B ALL, one patient (4%) had Pro-B ALL, two patients (8%) had mature B ALL and six patients (24%) had T ALL. Clonal chromosomal abnormalities was detected in 4 patients (complex chromosomal abnormalities in one patient and t (9; 22) in 3 patients). 21 were evaluable at day +28. Seventeen patients (68%) were in complete remission and four patients (16%) had refractor leukemia.None of the patients had osteoporosis either in the pre or post treatment evaluation (T-score < -2.5). Seven patient (28%) fulfilled the WHO criteria for osteopenia in the lumbar spine at diagnosis (T- score -1 to -2.5). At post-treatment evaluation, ten patients (40%) were found to have osteopenia as assessed at the lumbar spine. Yet the difference in bone density at the lumbar spine did not reach statistical significance (p-value >0.05). There was statistically significant reduction in the BMD at the left femoral neck, in the post treatment evaluation as compared to the pre treatment evaluation, with p-value <0.001.We have tried to correlate the bone density (BMD,T score, Z score) in femoral neck to several clinical variables in a multivariate analysis (age, sex, extra medullary disease, and Ph chromosome). However, we did not find any statistically significant correlation with any of the previous factors.
Summary
Skeletal morbidity, characterized by bone pain, osteonecrosis, fractures, loss of mobility, bone deformation, or osteopenia, is frequently encountered in patients affected by ALL. Clinically important sites for evaluation of osteopenia/ osteoporosis in adult are the lumbar spine (L2-L4), and femoral neck. Larger sized studies are required to draw more firm conclusions and to design screening and prophylactic programs.
Keyword(s): Acute lymphoblastic leukemia, Bone Density