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Su YW, Lee AMC, Xu X, Hua B, Tapp H, Wen XS, Xian CJ. Methotrexate Chemotherapy Causes Growth Impairments, Vitamin D Deficiency, Bone Loss, and Altered Intestinal Metabolism-Effects of Calcitriol Supplementation. Cancers (Basel) 2023; 15:4367. [PMID: 37686643 PMCID: PMC10486381 DOI: 10.3390/cancers15174367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Vitamin D deficiency or insufficiency is prevalent in childhood cancer patients and survivors after chemotherapy; further studies are needed to investigate the underlying aetiology and effectiveness of vitamin D supplementation in preventing chemotherapy-induced bone loss. This study used a rat model of treatment with antimetabolite methotrexate to investigate whether methotrexate chemotherapy causes vitamin D deficiency and if vitamin D supplementation attenuates the resultant bone loss. Methotrexate treatment (five daily injections) decreased serum vitamin D levels (from 52 to <30 ng/mL), reduced body and bone lengthening and tibial trabecular bone volume, and altered intestinal vitamin D metabolism, which was associated with intestinal mucosal damage known to cause malabsorption of nutrients, including dietary vitamin D and calcium. During the early stage after chemotherapy, mRNA expression increased for vitamin D activation enzyme CYP27B1 and for calcium-binding protein TRPV6 in the intestine. During the intestinal healing stage, expression of vitamin D catabolism enzyme CYP24 increased, and that of TRPV6 was normalised. Furthermore, subcutaneous calcitriol supplementation diminished methotrexate-induced bone loss due to its effect suppressing methotrexate-induced increased bone resorption. Thus, in young rats, methotrexate chemotherapy causes vitamin D deficiency, growth impairments, bone loss, and altered intestinal vitamin D metabolism, which are associated with intestinal damage, and vitamin D supplementation inhibits methotrexate-induced bone loss.
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Affiliation(s)
- Yu-Wen Su
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (Y.-W.S.); (A.M.C.L.); (X.X.); (B.H.)
| | - Alice M. C. Lee
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (Y.-W.S.); (A.M.C.L.); (X.X.); (B.H.)
| | - Xukang Xu
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (Y.-W.S.); (A.M.C.L.); (X.X.); (B.H.)
| | - Belinda Hua
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (Y.-W.S.); (A.M.C.L.); (X.X.); (B.H.)
| | - Heather Tapp
- Department of Haematology & Oncology, Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia;
| | - Xue-Sen Wen
- School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan 250012, China;
| | - Cory J. Xian
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (Y.-W.S.); (A.M.C.L.); (X.X.); (B.H.)
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Ross J, Bowden MR, Yu C, Diaz-Thomas A. Transition of young adults with metabolic bone diseases to adult care. Front Endocrinol (Lausanne) 2023; 14:1137976. [PMID: 37008909 PMCID: PMC10064010 DOI: 10.3389/fendo.2023.1137976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
As more accurate diagnostic tools and targeted therapies become increasingly available for pediatric metabolic bone diseases, affected children have a better prognosis and significantly longer lifespan. With this potential for fulfilling lives as adults comes the need for dedicated transition and intentional care of these patients as adults. Much work has gone into improving the transitions of medically fragile children into adulthood, encompassing endocrinologic conditions like type 1 diabetes mellitus and congenital adrenal hyperplasia. However, there are gaps in the literature regarding similar guidance concerning metabolic bone conditions. This article intends to provide a brief review of research and guidelines for transitions of care more generally, followed by a more detailed treatment of bone disorders specifically. Considerations for such transitions include final adult height, fertility, fetal risk, heritability, and access to appropriately identified specialists. A nutrient-dense diet, optimal mobility, and adequate vitamin D stores are protective factors for these conditions. Primary bone disorders include hypophosphatasia, X-linked hypophosphatemic rickets, and osteogenesis imperfecta. Metabolic bone disease can also develop secondarily as a sequela of such diverse exposures as hypogonadism, a history of eating disorder, and cancer treatment. This article synthesizes research by experts of these specific disorders to describe what is known in this field of transition medicine for metabolic bone diseases as well as unanswered questions. The long-term objective is to develop and implement strategies for successful transitions for all patients affected by these various conditions.
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Affiliation(s)
- Jordan Ross
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- *Correspondence: Jordan Ross,
| | - Michelle R. Bowden
- Division of General Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
| | - Christine Yu
- Endocrinology Division, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
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Safety and Efficacy of Alendronate to Treat Osteopenia in Children During Therapy for Acute Lymphoblastic Leukemia: A Retrospective Cohort Study of Sequential Outcomes. J Pediatr Hematol Oncol 2022; 45:200-206. [PMID: 36729669 DOI: 10.1097/mph.0000000000002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/07/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Low bone mineral density is encountered in children with acute lymphoblastic leukemia (ALL) before, during, and after treatment. Prior experience with alendronate, an oral bisphosphonate, demonstrated high tolerability and evident clinical efficacy. However, concerns have been expressed about the long-term safety and utility of such agents in children. PROCEDURE Sixty-nine children with ALL received alendronate for a mean of 87 weeks after dual-energy x-ray absorptiometry. Dual-energy x-ray absorptiometry was repeated following the completion of alendronate, and 5 to 9 years later in a subgroup of 32 children. Lumbar spine areal bone mineral density (LS aBMD) Z scores were obtained. RESULTS The mean LS aBMD Z score rose from -1.78 to-0.47 (P <0.0001). There was a modest median loss of LS aBMD subsequently in the 32 subjects on long-term follow-up. Almost 80% (N=172) of the children remain in continuous complete remission at a mean of 14.5 years from diagnosis. Of those who received alendronate, which was almost uniformly well tolerated, 7/69 (10.3%) relapsed compared with 19/89 (21.3%) who did not receive the drug. DISCUSSION Alendronate appears to be well tolerated and moderately effective in osteopenic children with ALL. Whether it offers protection against relapse of leukemia needs further study.
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Horiuchi K, Nemoto R, Mizuno T, Susa M, Chiba K. Prevalence of low bone mineral density and risk of fractures in osteosarcoma and Ewing's sarcoma survivors: A scoping review. J Bone Oncol 2022; 38:100464. [PMID: 36560961 PMCID: PMC9763837 DOI: 10.1016/j.jbo.2022.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Background The clinical outcomes of patients with pediatric cancer have significantly improved over the past few decades. However, the treatments are often highly intensive and can advertently pose a risk for developing various health conditions, including bone mass loss and fragility fractures. Since patients with bone malignancies, such as osteosarcoma (OS) and Ewing's sarcoma (ES), require musculoskeletal surgery as well as chemotherapy, OS/ES survivors are potentially at even greater risk of developing these musculoskeletal conditions than those with other types of cancer. However, these issues in OS/ES survivors are often overlooked by clinicians treating childhood cancers. Thus, this scoping review was designed and conducted to better understand the bone health conditions in OS/ES survivors. Design We conducted a literature search and included the studies that describe bone mineral density in association with bone health in OS/ES survivors for analysis. Data regarding patients' demographic, diagnosis, bone mineral density, laboratory examinations, and incidence of fractures were extracted and evaluated. Results We found that almost half of OS/ES survivors have bone mass deficit and that several factors (such as a frailer physique and younger age at diagnosis) are potentially associated with low bone mass in OS/ES survivors. On the other hand, due to a paucity of information currently available, we could not determine whether long-term OS/ES survivors would ultimately regain bone mass or be at a greater risk of fragility fractures. Conclusions This scoping review reveals a previously unappreciated knowledge gap in our understanding of bone health conditions in OS/ES survivors and raises awareness among clinicians and care providers of this condition that OS/ES patients may encounter after successful treatment.
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Affiliation(s)
- Keisuke Horiuchi
- Department of Orthopedic Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan,Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan,Corresponding author at: Department of Orthopedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
| | - Ryuji Nemoto
- Department of Orthopedic Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan
| | - Tsukasa Mizuno
- Department of Orthopedic Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan
| | - Michiro Susa
- Department of Orthopedic Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan
| | - Kazuhiro Chiba
- Department of Orthopedic Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan
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Saultier P, Simonin M, Beaumais TAD, Rialland F, Alby-Laurent F, Lubnau M, Desplantes C, Jacqz-Aigrain E, Rohrlich P, Reguerre Y, Rabian F, Sirvent N, Plat GW, Petit A. [Practical management during maintenance therapy of pediatric acute lymphoblastic leukemia: Recommendations of the French Society for Childhood and Adolescent Cancer and Leukemia (SFCE)]. Bull Cancer 2022; 109:1132-1143. [PMID: 35863954 DOI: 10.1016/j.bulcan.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
Maintenance therapy is the last phase of treatment for acute lymphoblastic leukemia in children and adolescents. Although maintenance therapy is associated with toxicities and specific management issues, it is an essential phase of treatment that reduces the risk of relapse. The objective of this work is to propose a guide for the initiation, administration, and monitoring of maintenance therapy, and for the management of food, schooling, leisure, community life, risk of infection and links with family medicine.
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Affiliation(s)
- Paul Saultier
- Hôpital de la Timone Enfants, APHM, service d'hématologie, immunologie et oncologie pédiatrique, Marseille, France.
| | - Mathieu Simonin
- AP-HP, hôpital Armand-Trousseau, Sorbonne université, service d'hématologie et oncologie pédiatrique, Paris, France
| | | | - Fanny Rialland
- CHU de Nantes, service d'onco-hématologie pédiatrique, Nantes, France
| | - Fanny Alby-Laurent
- AP-HP, hôpital Armand-Trousseau, Sorbonne université, service d'hématologie et oncologie pédiatrique, Paris, France
| | - Marion Lubnau
- CHU de Nancy, service d'onco-hématologie pédiatrique, Nancy, France
| | | | - Evelyne Jacqz-Aigrain
- AP-HP, hôpital Saint-Louis, département de pharmacologie et pharmacogénétique, Paris, France
| | - Pierre Rohrlich
- CHU de Nice, service d'hématologie pédiatrique, Nice, France
| | - Yves Reguerre
- CHU de la Réunion, service d'hémato-oncologie pédiatrique, Réunion, France
| | - Florence Rabian
- AP-HP, hôpital Saint-Louis, service d'hématologie adolescents et jeunes adultes, Paris, France
| | - Nicolas Sirvent
- CHU de Montpellier, service d'hématologie et oncologie pédiatrique, Montpellier, France
| | - Geneviève Willson Plat
- CHU de Toulouse, service d'hématologie oncologie et immunologie pédiatrique, Toulouse, France
| | - Arnaud Petit
- AP-HP, hôpital Armand-Trousseau, Sorbonne université, service d'hématologie et oncologie pédiatrique, Paris, France
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6
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Watson C, Gadikota H, Barlev A, Beckerman R. A review of the risks of long-term consequences associated with components of the CHOP chemotherapy regimen. J Drug Assess 2022; 11:1-11. [PMID: 35693477 PMCID: PMC9176678 DOI: 10.1080/21556660.2022.2073101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A common chemotherapy regimen in post-transplant lymphoproliferative disease (PTLD) following solid organ transplants (SOT) is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). This study reviews the quantitative evidence for long-term consequences associated with components of CHOP identified from the Children's Oncology Group Long-Term Follow-Up Guidelines. Cited references were screened using prespecified criteria (English, systematic review, randomized controlled trial n > 100, observation study n > 100, case series n > 20). Relevant data were extracted and synthesized. Of 61 studies, 66% were retrospective cohort studies, 28% were in the US, and 95% enrolled pediatric patients. No study focused specifically on the CHOP regimen. Long-term consequences for CHOP components observed in >3 studies included cardiac toxicity (n = 14), hormone deficiencies/infertility (n = 14), secondary leukemia (n = 7), osteonecrosis (n = 6), and bladder cancer (n = 4). These effects are significant, impact a high percentage of patients, and occur as early as one year after treatment. Although none of the studies focused specifically on the CHOP regimen, 30%, 23%, and 15% evaluated alkylating agents (e.g. cyclophosphamide), anthracyclines (e.g. doxorubicin), and corticosteroids (e.g. prednisone), respectively. All three product classes had a dose-dependent risk of long-term consequences with up to 13.2-fold, 27-fold, 16-fold, 14.5-fold, and 6.2-fold increase in risk of heart failure, early menopause, secondary leukemia, bladder cancer, and osteonecrosis, respectively. Lymphoma patients had significantly elevated risks of cardiac toxicity (up to 12.2-fold), ovarian failure (up to 3.8-fold), and osteonecrosis (up to 6.7-fold). No studies were found in PTLD or SOT. Safe and effective PTLD treatments that potentially avoid these long-term consequences are urgently needed.
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Affiliation(s)
- Crystal Watson
- Atara Biotherapeutics Inc., South San Francisco, CA, USA
| | | | - Arie Barlev
- Atara Biotherapeutics Inc., South San Francisco, CA, USA
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7
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van Atteveld JE, Mulder RL, van den Heuvel-Eibrink MM, Hudson MM, Kremer LCM, Skinner R, Wallace WH, Constine LS, Higham CE, Kaste SC, Niinimäki R, Mostoufi-Moab S, Alos N, Fintini D, Templeton KJ, Ward LM, Frey E, Franceschi R, Pavasovic V, Karol SE, Amin NL, Vrooman LM, Harila-Saari A, Demoor-Goldschmidt C, Murray RD, Bardi E, Lequin MH, Faienza MF, Zaikova O, Berger C, Mora S, Ness KK, Neggers SJCMM, Pluijm SMF, Simmons JH, Di Iorgi N. Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: evidence-based recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Diabetes Endocrinol 2021; 9:622-637. [PMID: 34339631 PMCID: PMC8744935 DOI: 10.1016/s2213-8587(21)00173-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 02/01/2023]
Abstract
Childhood, adolescent, and young adult cancer survivors are at increased risk of reduced bone mineral density. Clinical practice surveillance guidelines are important for timely diagnosis and treatment of these survivors, which could improve bone mineral density parameters and prevent fragility fractures. Discordances across current late effects guidelines necessitated international harmonisation of recommendations for bone mineral density surveillance. The International Late Effects of Childhood Cancer Guideline Harmonization Group therefore established a panel of 36 experts from ten countries, representing a range of relevant medical specialties. The evidence of risk factors for very low and low bone mineral density and fractures, surveillance modality, timing of bone mineral density surveillance, and treatment of very low and low bone mineral density were evaluated and critically appraised, and harmonised recommendations for childhood, adolescent, and young adult cancer survivors were formulated. We graded the recommendations based on the quality of evidence and balance between potential benefits and harms. Bone mineral density surveillance is recommended for survivors treated with cranial or craniospinal radiotherapy and is reasonable for survivors treated with total body irradiation. Due to insufficient evidence, no recommendation can be formulated for or against bone mineral density surveillance for survivors treated with corticosteroids. This surveillance decision should be made by the survivor and health-care provider together, after careful consideration of the potential harms and benefits and additional risk factors. We recommend to carry out bone mineral density surveillance using dual-energy x-ray absorptiometry at entry into long-term follow-up, and if normal (Z-score > -1), repeat when the survivor is aged 25 years. Between these measurements and thereafter, surveillance should be done as clinically indicated. These recommendations facilitate evidence-based care for childhood, adolescent, and young adult cancer survivors internationally.
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Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - W Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Sue C Kaste
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Riitta Niinimäki
- Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, The Children's Hospital of Philadelphia, and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nathalie Alos
- Department of Pediatrics, Endocrinology Division, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Danilo Fintini
- Endocrinology Unit, University-Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Kimberly J Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Eva Frey
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Vienna, Austria
| | | | - Vesna Pavasovic
- Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Seth E Karol
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nadia L Amin
- Department of Paediatric Haematology, Leeds Children's Hospital, Leeds, UK
| | - Lynda M Vrooman
- Dana-Farber Cancer Institute, and Boston Children's Hospital, Boston, MA, USA
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Demoor-Goldschmidt
- INSERM U1018, Paris-Sud XI University, Paris-Saclay University, Centre for Research in Epidemiology and Population Health, Cancer & Radiations Group, Gustave Roussy Cancer Campus, Villejuif, France; Department of Pediatric Onco-hematology, CHU Angers, Angers, France; Department of Radiotherapy, François Baclesse Center, Caen, France
| | - Robert D Murray
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria; Department of Pediatrics and Adolescent Medicine, Kepler Universitätsklinikum, Linz, Austria
| | - Maarten H Lequin
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University A Moro, Bari, Italy
| | - Olga Zaikova
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Claire Berger
- Department for Pediatric Hematology and Oncology CHU Nord, University Hospital Saint-Etienne, Saint-Priest en Jarez, France; 28U1059 Sainbiose, University Jean Monnet, Saint-Etienne, France
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology and Pediatric Bone Density Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jill H Simmons
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natascia Di Iorgi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy and Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
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8
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van Atteveld JE, Verhagen IE, van den Heuvel-Eibrink MM, van Santen HM, van der Sluis IM, Di Iorgi N, Simmons JH, Ward LM, Neggers SJCMM. Vitamin D supplementation for children with cancer: A systematic review and consensus recommendations. Cancer Med 2021; 10:4177-4194. [PMID: 34100559 PMCID: PMC8267124 DOI: 10.1002/cam4.4013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/29/2022] Open
Abstract
Background Prevalent vitamin D deficiency (VDD) and low bone mineral density (BMD) have led to vitamin D supplementation for children with cancer, regardless vitamin D status. However, it remains unsettled whether this enhances bone strength. We sought to address this issue by carrying out a systematic review of the literature. Methods We conducted a literature search using PubMed, Embase, and Cochrane databases. Studies including children up to 5 years after cancer therapy were assessed for the association between 25‐hydroxyvitamin D (25OHD) levels and BMD Z‐scores or fractures, and the effect of vitamin D supplementation on BMD or fractures. Evidence quality was assessed using the GRADE methodology. Results Nineteen studies (16 observational and 3 interventional, mainly involving children with hematologic malignancies) were included. One study which analyzed 25OHD as a threshold variable (≤10 ng/ml) found a significant association between 25OHD levels and BMD Z‐scores, while 25OHD as a continuous variable was not significantly associated with BMD Z‐scores in 14 observational studies. We found neither a significant association between lower 25OHD levels and fractures (2 studies), nor between vitamin D (and calcium) supplementation and BMD or fracture frequency (3 studies) (very low quality evidence). Conclusion There is a lack of evidence for an effect of vitamin D (and calcium) supplementation on BMD or fractures in children with cancer. Further research is needed; until then, we recommend dietary vitamin D/calcium intake in keeping with standard national guidelines, and periodic 25OHD monitoring to detect levels <20 ng/ml. Vitamin D/calcium supplementation is recommended in children with low levels, to maintain levels ≥20 ng/ml year‐long.
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Affiliation(s)
| | - Iris E Verhagen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Endocrinology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Natascia Di Iorgi
- Department of Pediatrics, University of Genova, IRCCS Istituto Giannina Gaslini, Genova, GE, Italy
| | - Jill H Simmons
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
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9
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Latoch E, Konstantynowicz J, Krawczuk-Rybak M, Panasiuk A, Muszyńska-Rosłan K. A long-term trajectory of bone mineral density in childhood cancer survivors after discontinuation of treatment: retrospective cohort study. Arch Osteoporos 2021; 16:45. [PMID: 33635381 DOI: 10.1007/s11657-020-00863-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/07/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Low bone mineral density (BMD) was diagnosed in 24% of childhood cancer survivors (CCS), whereas very low BMD was relatively uncommon at 8%. We suggest that low BMD in CCS may become alleviated over time. Stem cell transplantation, radiotherapy, and underweight were the strongest independent predictors of decreased BMD. PURPOSE Childhood cancer survivors (CCS) are at risk of premature bone loss, although published studies are inconsistent. The objective of this study was to evaluate the prevalence and pattern of low bone mineral density (BMD) in short- and long-term CCS, and to determine clinical factors affecting skeleton after anticancer treatment. METHODS This retrospective study was conducted in a cohort of 326 children and young adult CCS (147 females) who completed anticancer treatment. BMD was determined by dual-energy X-ray absorptiometry (DXA). Low BMD was defined as a Z-score ≤ - 1.0, and the very low BMD as a Z-score ≤ - 2.0. Additionally, the changes in BMD over time were studied in 123 CCS who had been re-examined by DXA during follow-up. RESULTS Median age at diagnosis was 7.27 years (range, 4.4-10.6); median time between end of treatment and DXA was 6.12 (range, 4.0-22.0). Low BMD was found in 24% of CCS, while very low BMD was relatively uncommon (8%). Based on multivariate analysis, the following were significantly associated with low BMD at the follow-up: hematopoietic stem cell transplantation (OR 3.13, 95% CI 1.02-9.63), head and neck radiotherapy (OR 2.54, 95% CI 1.32-4.90), and body weight below the standard reference (OR 3.57, 95% CI 1.24-10.23). The time-related trajectory showed an improvement (BMDLS) or stabilization (BMDTB) in Z-scores values. CONCLUSION These data based on serial DXA measurements, encompassing a long-lasting observation period, show that CCS may not be at risk of premature bone loss in young adulthood. However, it is unknown how the scenario for skeletal mass is until the CCS will achieve older or postmenopausal age.
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Affiliation(s)
- Eryk Latoch
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Białystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children's Hospital 'Dr Ludwik Zamenhof', ul. Waszyngtona 17, 15-274, Białystok, Poland.
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Białystok, Poland
| | - Anna Panasiuk
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wrocław, Poland
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10
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Gil-Cosano JJ, Ubago-Guisado E, Sánchez MJ, Ortega-Acosta MJ, Mateos ME, Benito-Bernal AI, Llorente-Cantarero FJ, Ortega FB, Ruiz JR, Labayen I, Martinez-Vizcaino V, Vlachopoulos D, Arroyo-Morales M, Muñoz-Torres M, Pascual-Gázquez JF, Vicho-González MC, Gracia-Marco L. The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial. BMC Public Health 2020; 20:1520. [PMID: 33032564 PMCID: PMC7545891 DOI: 10.1186/s12889-020-09607-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health. METHODS A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health. DISCUSSION Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society. TRIAL REGISTRATION Prospectively registered in isrctn.com: isrctn61195625 . Registered 2 April 2020.
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Affiliation(s)
- Jose J Gil-Cosano
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Esther Ubago-Guisado
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Maria J Sánchez
- Andalusian School of Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Maria J Ortega-Acosta
- Servicio de Pediatría y Oncohematología Pediátricas, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Maria E Mateos
- Pediatric Oncology Unit, Department of Pediatrics, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
| | | | - Francisco J Llorente-Cantarero
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), 28029, Madrid, Spain
- Department of Specific Didactics, Faculty of Education, University of Córdoba, 14071, Córdoba, Spain
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Jonatan R Ruiz
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Idoia Labayen
- Institute for Innovation and Sustainable Development in Food Chain (IS-FOOD), Navarra's Health Research Institute (IdiSNA), Department of Health Sciences, Public University of Navarra, Calle Tajonar 22, 31006, Pamplona, Navarra, Spain
| | - Vicente Martinez-Vizcaino
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Talca, Chile
| | - Dimitris Vlachopoulos
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Manuel Arroyo-Morales
- Biohealth Research Institute in Granada (ibs.GRANADA), E-18012, Granada, Spain
- Department of Physiotherapy, University of Granada, E-18016, Granada, Spain
- "Cuídate" Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS), E-18016, Granada, Spain
| | - Manuel Muñoz-Torres
- Bone Metabolic Unit, Endocrinology and Nutrition Division, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Granada, Spain
- CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Universidad de Granada, Granada, Spain
| | - Juan F Pascual-Gázquez
- Servicio de Pediatría y Oncohematología Pediátricas, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Maria C Vicho-González
- Pediatric Oncology Unit, Department of Pediatrics, Reina Sofia University Hospital, Córdoba, Spain
| | - Luis Gracia-Marco
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain.
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11
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Cohen J, Collins L, Gregerson L, Chandra J, Cohn RJ. Nutritional concerns of survivors of childhood cancer: A "First World" perspective. Pediatr Blood Cancer 2020; 67 Suppl 3:e28193. [PMID: 31994836 DOI: 10.1002/pbc.28193] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/12/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022]
Abstract
Childhood cancer survivor (CCS) numbers are increasing as a result of advances in both treatment and supportive care. This positive outcome is tempered by the recognition of a high burden of chronic health conditions. Here, we review the nutritional concerns of CCS, including dietary habits after treatment and the factors during treatment that may contribute to chronic health conditions. Dietary interventions that have been conducted in CCS will be summarized along with focused goals of these interventions. We will also address the need to leverage these interventions to reduce the risk of chronic disease in CCS.
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Affiliation(s)
- Jennifer Cohen
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Laura Collins
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Laura Gregerson
- Department of Nutrition, Exercises and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Joya Chandra
- Departments of Pediatrics Research, Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Randwick, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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12
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Ahn MB, Suh BK. Bone morbidity in pediatric acute lymphoblastic leukemia. Ann Pediatr Endocrinol Metab 2020; 25:1-9. [PMID: 32252210 PMCID: PMC7136509 DOI: 10.6065/apem.2020.25.1.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022] Open
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. Dual-energy 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.
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Affiliation(s)
- Moon Bae Ahn
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Byung-Kyu Suh
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea,Address for correspondence: Byung-Kyu Suh, MD, PhD Department of Pediatrics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6756 Fax: +82-2-537-4544 E-mail:
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13
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Kuhlen M, Kunstreich M, Niinimäki R, Dunstheimer D, Lawitschka A, Bardi E, Willasch A, Bader P, Högler W, Peters C, Balduzzi A. Guidance to Bone Morbidity in Children and Adolescents Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2020; 26:e27-e37. [DOI: 10.1016/j.bbmt.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/12/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022]
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14
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Salchow J, Mann J, Koch B, von Grundherr J, Jensen W, Elmers S, Straub LA, Vettorazzi E, Escherich G, Rutkowski S, Dwinger S, Bergelt C, Sokalska-Duhme M, Bielack S, Calaminus G, Baust K, Classen CF, Rössig C, Faber J, Faller H, Hilgendorf I, Gebauer J, Langer T, Metzler M, Schuster S, Niemeyer C, Puzik A, Reinhardt D, Dirksen U, Sander A, Köhler M, Habermann JK, Bokemeyer C, Stein A. Comprehensive assessments and related interventions to enhance the long-term outcomes of child, adolescent and young adult cancer survivors - presentation of the CARE for CAYA-Program study protocol and associated literature review. BMC Cancer 2020; 20:16. [PMID: 31906955 PMCID: PMC6945396 DOI: 10.1186/s12885-019-6492-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/23/2019] [Indexed: 12/21/2022] Open
Abstract
Background Improved, multimodal treatment strategies have been shown to increase cure rates in cancer patients. Those who survive cancer as a child, adolescent or young adult (CAYA), are at a higher risk for therapy-, or disease-related, late or long-term effects. The CARE for CAYA-Program has been developed to comprehensively assess any potential future problems, to offer need-based preventative interventions and thus to improve long-term outcomes in this particularly vulnerable population. Methods The trial is designed as an adaptive trial with an annual comprehensive assessment followed by needs stratified, modular interventions, currently including physical activity, nutrition and psycho-oncology, all aimed at improving the lifestyle and/or the psychosocial situation of the patients. Patients, aged 15–39 years old, with a prior cancer diagnosis, who have completed tumour therapy and are in follow-up care, and who are tumour free, will be included. At baseline (and subsequently on an annual basis) the current medical and psychosocial situation and lifestyle of the participants will be assessed using a survey compiled of various validated questionnaires (e.g. EORTC QLQ C30, NCCN distress thermometer, PHQ-4, BSA, nutrition protocol) and objective parameters (e.g. BMI, WHR, co-morbidities like hyperlipidaemia, hypertension, diabetes), followed by basic care (psychological and lifestyle consultation). Depending on their needs, CAYAs will be allocated to preventative interventions in the above-mentioned modules over a 12-month period. After 1 year, the assessment will be repeated, and further interventions may be applied as needed. During the initial trial phase, the efficacy of this approach will be compared to standard care (waiting list with intervention in the following year) in a randomized study. During this phase, 530 CAYAs will be included and 320 eligible CAYAs who are willing to participate in the interventions will be randomly allocated to an intervention. Overall, 1500 CAYAs will be included and assessed. The programme is financed by the innovation fund of the German Federal Joint Committee and will be conducted at 14 German sites. Recruitment began in January 2018. Discussion CAYAs are at high risk for long-term sequelae. Providing structured interventions to improve lifestyle and psychological situation may counteract against these risk factors. The programme serves to establish uniform regular comprehensive assessments and need-based interventions to improve long-term outcome in CAYA survivors. Trial registration Registered at the German Clinical Trial Register (ID: DRKS00012504, registration date: 19th January 2018).
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Affiliation(s)
- J Salchow
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - J Mann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Koch
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J von Grundherr
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Jensen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Elmers
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L A Straub
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Vettorazzi
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Escherich
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Rutkowski
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Dwinger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bergelt
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - S Bielack
- Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | | | - K Baust
- University Hospital Bonn, Bonn, Germany
| | - C F Classen
- University Hospital Rostock, Rostock, Germany
| | - C Rössig
- University Children's Hospital Münster, Münster, Germany
| | - J Faber
- Mainz University Medical Center, Mainz, Germany
| | - H Faller
- University Hospital Würzburg, Würzburg, Germany
| | | | - J Gebauer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - T Langer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - M Metzler
- University Hospital Erlangen, Erlangen, Germany
| | - S Schuster
- University Hospital Erlangen, Erlangen, Germany
| | - C Niemeyer
- Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Puzik
- Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Reinhardt
- University Hospital Essen, Essen, Germany.,German Cancer Consortium, Essen, Germany
| | - U Dirksen
- University Hospital Essen, Essen, Germany.,German Cancer Consortium, Essen, Germany
| | - A Sander
- Hannover Medical School, Hannover, Germany
| | - M Köhler
- Medical Faculty University Hospital Magdeburg, Magdeburg, Germany
| | | | - C Bokemeyer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stein
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Abstract
Glucocorticoids (GC) are an important risk factor for bone fragility in children with serious illnesses, largely due to their direct adverse effects on skeletal metabolism. To better appreciate the natural history of fractures in this setting, over a decade ago the Canadian STeroid-associated Osteoporosis in the Pediatric Population ("STOPP") Consortium launched a 6 year, multi-center observational cohort study in GC-treated children. This study unveiled numerous key clinical-biological principles about GC-induced osteoporosis (GIO), many of which are unique to the growing skeleton. This was important, because most GIO recommendations to date have been guided by adult studies, and therefore do not acknowledge the pediatric-specific principles that inform monitoring, diagnosis and treatment strategies in the young. Some of the most informative observations from the STOPP study were that vertebral fractures are the hallmark of pediatric GIO, they occur early in the GC treatment course, and they are frequently asymptomatic (thereby undetected in the absence of routine monitoring). At the same time, some children have the unique, growth-mediated ability to restore normal vertebral body dimensions following vertebral fractures. This is an important index of recovery, since spontaneous vertebral body reshaping may preclude the need for osteoporosis therapy. Furthermore, we now better understand that children with poor growth, older children with less residual growth potential, and children with ongoing bone health threats have less potential for vertebral body reshaping following spine fractures, which can result in permanent vertebral deformity if treatment is not initiated in a timely fashion. Therefore, pediatric GIO management is now predicated upon early identification of vertebral fractures in those at risk, and timely intervention when there is limited potential for spontaneous recovery. A single, low-trauma long bone fracture can also signal an osteoporotic event, and a need for treatment. Intravenous bisphosphonates are currently the recommended therapy for pediatric GC-induced bone fragility, typically prescribed to children with limited potential for medication-unassisted recovery. It is recognized, however, that even early identification of bone fragility, combined with timely introduction of intravenous bisphosphonate therapy, may not completely rescue the osteoporosis in those with the most aggressive forms, opening the door to novel strategies.
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16
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Early Lifestyle Intervention for Obesity Prevention in Pediatric Survivors of Acute Lymphoblastic Leukemia. Nutrients 2019; 11:nu11112631. [PMID: 31684118 PMCID: PMC6893453 DOI: 10.3390/nu11112631] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 02/02/2023] Open
Abstract
Patients with pediatric acute lymphoblastic leukemia (ALL) experience rapid weight gain during treatment and increases in weight are maintained throughout treatment and beyond. Without prompt interventions, altered dietary and physical activity behaviors may become difficult to reverse, contributing to obesity risk long-term. Fifteen children, aged 3–9 years, diagnosed with pediatric ALL who were on maintenance therapy or within two years of treatment completion (mean BMI percentile: 70.4th) and one parent from each family, were enrolled into a 12-week lifestyle intervention delivered remotely through web-based sessions and phone calls with a lifestyle coach. Outcomes were assessed at baseline and end of the intervention. Thirteen of the 15 enrolled families (86.7%) completed the intervention. Parents reduced the “pressure to eat” feeding practice (change in mean score: −0.60, 95% CI: −1.12 to −0.07; p-value = 0.03) post intervention. Children increased the consumption of milk (0.54 serving/d, 0.02 to 1.07; p-value = 0.04) and percent of calories from protein (2.54%, 0.22 to 4.87%; p-value = 0.04) and reduced the consumption of potatoes (−0.16 serving/d, -0.30 to −0.03; p-value = 0.02). No significant changes were observed for children’s levels of physical activity, BMI, or waist circumference. Results from this pilot support the feasibility and preliminary efficacy of early lifestyle intervention among pediatric ALL survivors.
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17
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Griffin N, Dowling M. Vitamin D supplementation and clinical outcomes in cancer survivorship. ACTA ACUST UNITED AC 2019; 27:1121-1128. [PMID: 30346823 DOI: 10.12968/bjon.2018.27.19.1121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increasing evidence points to the role of vitamin D supplementation in cancer management. A comprehensive search of online databases was undertaken for all research studies relating to vitamin D supplementation in cancer survivorship published up to November 2017. Eighteen studies meeting the inclusion criteria were selected for this review, the majority of which involved supplementation in breast cancer. This review concludes that vitamin D supplementation plays an important role in disease-free survival in a number of cancers, particularly breast. In other cancers, the role of supplementation is less clear, and more research is required. More research is also required to investigate the most effective dose and duration of vitamin D supplementation to benefit cancer survivors.
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Affiliation(s)
- Niamh Griffin
- Graduate nurse, at time of writing this article final-year undergraduate student, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Maura Dowling
- Senior Lecturer, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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18
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Bloomhardt HM, Sint K, Ross WL, Rotatori J, Ness K, Robinson C, Carpenter TO, Chow EJ, Kadan-Lottick NS. Severity of reduced bone mineral density and risk of fractures in long-term survivors of childhood leukemia and lymphoma undergoing guideline-recommended surveillance for bone health. Cancer 2019; 126:202-210. [PMID: 31536650 DOI: 10.1002/cncr.32512] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/30/2019] [Accepted: 08/18/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivors of childhood leukemia/lymphoma are at increased risk for reduced bone mineral density (BMD). The authors sought to determine the frequency of reduced BMD detected by off-therapy surveillance, factors associated with reduced BMD, and the association of reduced BMD with fractures. METHODS This cross-sectional study included childhood leukemia/lymphoma survivors attending 2 survivorship clinics who received guideline-recommended BMD surveillance ≥2 years post-therapy with dual-energy x-ray absorptiometry (from January 1, 2004 to August 31, 2016). Lumbar spine BMD z-scores were height-for-age-adjusted. Low and very low BMD were >1 SD and >2 SDs below norms, respectively. Treatment, chronic conditions, and fractures were abstracted from medical records. Logistic regression was used to examine the association of low BMD with patient/treatment factors and fractures. RESULTS In total, 542 patients (51.5% female) with a mean age of 15.5 years (range, 4.4-52.2 years) who were 6 years post-therapy (range, 2.0-35.1 years) were evaluated, including 116 who reported post-therapy fractures. Lumbar spine low BMD was identified in 17.2% of survivors, and very low BMD was identified in 3.5% of survivors, but frequencies varied considerably between subgroups; 10.8% of survivors aged 15 to 19 years at diagnosis had very low BMD. In multivariable analyses, older age at diagnosis, white race, and being underweight were significantly associated with low BMD. Survivors with low BMD had greater odds of nondigit fractures (odds ratio, 2.2; 95% CI, 1.3-3.7) and specifically long-bone fractures (odds ratio, 2.7; 95% CI, 1.5-4.7). CONCLUSIONS In this study of childhood leukemia/lymphoma survivors undergoing guideline-recommended dual-energy x-ray absorptiometry surveillance, patients who were older at diagnosis, white, and underweight were at the highest risk for lumbar spine low BMD. Low BMD was associated with a greater risk of fractures, emphasizing the clinical importance of surveillance.
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Affiliation(s)
- Hadley M Bloomhardt
- Department of Pediatrics (Hematology-Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Kyaw Sint
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Wilhelmenia L Ross
- Department of Pediatrics (Hematology-Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Jaime Rotatori
- Department of Pediatrics (Hematology-Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Kathryn Ness
- Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Cemre Robinson
- Department of Pediatrics (Endocrinology), Yale School of Medicine, New Haven, Connecticut
| | - Thomas O Carpenter
- Department of Pediatrics (Endocrinology), Yale School of Medicine, New Haven, Connecticut
| | - Eric J Chow
- Seattle Children's Hospital, University of Washington, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nina S Kadan-Lottick
- Department of Pediatrics (Hematology-Oncology), Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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19
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van Atteveld JE, Pluijm SM, Ness KK, Hudson MM, Chemaitilly W, Kaste SC, Robison LL, Neggers SJ, Yasui Y, van den Heuvel-Eibrink MM, Wilson CL. Prediction of Low and Very Low Bone Mineral Density Among Adult Survivors of Childhood Cancer. J Clin Oncol 2019; 37:2217-2225. [PMID: 31169453 PMCID: PMC6804829 DOI: 10.1200/jco.18.01917] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To develop and validate prediction models for low and very low bone mineral density (BMD) on the basis of clinical and treatment characteristics that identify adult survivors of childhood cancer who require screening by dual-energy x-ray absorptiometry. PATIENTS AND METHODS White survivors of childhood cancer (n = 2,032; median attained age, 29.3 years [range, 18.1 to 40.9 years]) enrolled in the St Jude Lifetime Cohort (SJLIFE; development) and survivors treated at the Erasmus Medical Center (validation) in the Netherlands (n = 403; median age, 24.2 years [range, 18.0 to 40.9 years]) were evaluated with dual-energy x-ray absorptiometry to determine lumbar spine BMD and total-body BMD. Low and very low BMD were defined as lumbar spine BMD and/or total-body BMD z scores of -1 or lower or -2 or lower, respectively. Multivariable logistic regression was used to build prediction models; performance was assessed using receiver operating characteristic curves. Diagnostic values were calculated at different probabilities. RESULTS Low BMD was present in 51% and 45% of SJLIFE and Dutch participants, respectively, and very low BMD was present in 20% and 10%, respectively. The model for low BMD included male sex (odds ratio [OR], 3.07), height (OR, 0.95), weight (OR, 0.98), attained age (OR, 0.97), current smoking status (OR, 1.48), and cranial irradiation (OR, 2.11). Areas under the curve were 0.72 (95% CI, 0.70 to 0.75) in the SJLIFE cohort and 0.69 (95% CI, 0.64 to 0.75) in the Dutch cohort. The sum of the sensitivity (69.0%) and specificity (64.0%) was maximal at the predicted probability of 50%. The model for very low BMD included male sex (OR, 3.28), height (OR, 0.95), weight (OR, 0.97), attained age (OR, 0.98), cranial irradiation (OR, 2.07), and abdominal irradiation (OR, 1.61), yielding areas under the curve of 0.76 (95% CI, 0.73 to 0.78; SJLIFE cohort) and 0.75 (95% CI, 0.67 to 0.83; Dutch cohort). CONCLUSION Validated prediction models for low and very low BMD, using easily measured patient and treatment characteristics, correctly identified BMD status in most white adult survivors through age 40 years.
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Affiliation(s)
| | - Saskia M.F. Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | - Sue C. Kaste
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | | | - Sebastian J.C.M.M. Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Yutaka Yasui
- St Jude Children’s Research Hospital, Memphis, TN
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20
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Mostoufi-Moab S, Ward LM. Skeletal Morbidity in Children and Adolescents during and following Cancer Therapy. Horm Res Paediatr 2019; 91:137-151. [PMID: 30481777 PMCID: PMC6536370 DOI: 10.1159/000494809] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/23/2018] [Indexed: 01/07/2023] Open
Abstract
Skeletal abnormalities are common in children and adolescents diagnosed and treated for a malignancy. The spectrum ranges from mild pain to debilitating osteonecrosis and fractures. In this review, we summarize the impact of cancer therapy on the developing skeleton, provide an update on therapeutic strategies for prevention and treatment, and discuss the most recent advances in musculoskeletal research. Early recognition of skeletal abnormalities and strategies to optimize bone health are essential to prevent long-term skeletal sequelae and diminished quality of life in childhood cancer survivors.
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Affiliation(s)
- Sogol Mostoufi-Moab
- Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,
| | - Leanne M. Ward
- Department of Pediatrics, The Children’s Hospital of Eastern Ontario, University of Ottawa, Ontario, Canada, K1H 8L1
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21
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Erdem M, Tüfekçi Ö, Kızıldağ S, Yılmaz Ş, Kızmazoğlu D, Eroğlu Filibeli B, Ören H. Investigation of the Relationship Between Fok1 and Col1A1 Gene Polymorphisms and Development of Treatment-Related Bone Complications in Children with Acute Lymphoblastic Leukemia. Turk J Haematol 2018; 36:12-18. [PMID: 30251958 PMCID: PMC6373515 DOI: 10.4274/tjh.galenos.2018.2018.0221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: In acute lymphoblastic leukemia (ALL), various clinical risk factors and genetic predispositions contribute to the development of bone complications during and after chemotherapy. In this study, we aimed to investigate whether vitamin D receptor (VDR) Fok1 and collagen protein Col1A1 Sp1-binding site gene polymorphisms, which are important in bone mineral and matrix formation, have effects on the development of bone abnormalities in childhood ALL survivors. Materials and Methods: Fifty children with ALL who were treated with the ALL Berlin-Frankfurt-Muenster-95 protocol between 1998 and 2008 and were followed for at least 7 years were enrolled. The control group consisted of 96 healthy children. VDR Fok1 and Col1A1 Sp1-binding site gene polymorphisms were analyzed by polymerase chain reaction and restriction fragment length polymorphism. Bone mineral density (BMD) and markers of bone metabolism were all noted. All patients who presented with pain in the joints were examined for bone pathologies while on chemotherapy or during long-term follow-up. Results: Low BMD (16%), osteoporosis (12%), and osteonecrosis (8%) were present in a total of 18 patients (36%). The frequency of osteonecrosis and total bone abnormalities was significantly higher in children aged ≥10 years (p=0.001). The risk of low BMD and osteonecrosis was higher in those with vitamin D deficiency. Only the Col1A1 Sp1-binding site gene polymorphism showed a significant association in ALL patients with osteonecrosis. Conclusion: The development of therapy-induced bone mineral loss and osteonecrosis in children with ALL is frequent and the risk is especially higher in children aged ≥10 years and with vitamin D deficiency. The association between Col1A1 Sp1-binding site gene polymorphisms and osteonecrosis has to be assessed in a larger group of ALL survivors.
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Affiliation(s)
- Melek Erdem
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Özlem Tüfekçi
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Sefa Kızıldağ
- Dokuz Eylül University Faculty of Medicine, Department of Medical Biology, İzmir, Turkey
| | - Şebnem Yılmaz
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Deniz Kızmazoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Berna Eroğlu Filibeli
- Dokuz Eylül University Facullty of Medicine, Department of Pediatrics, İzmir, Turkey
| | - Hale Ören
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
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22
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Jackson TJ, Mostoufi-Moab S, Hill-Kayser C, Balamuth NJ, Arkader A. Musculoskeletal complications following total body irradiation in hematopoietic stem cell transplant patients. Pediatr Blood Cancer 2018; 65. [PMID: 29286549 DOI: 10.1002/pbc.26905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 01/13/2023]
Abstract
Total body irradiation (TBI) is commonly used in conditioning regimens for allogeneic hematopoietic stem cell transplantation (HSCT) to treat benign and malignant disease. Though life-saving, these therapies place patients at risk for important side effects, including musculoskeletal complications such as short stature, osteonecrosis, slipped capital femoral epiphysis, and the development of benign and malignant bone tumors. With an increasing number of HSCT survivors, there is a growing need for awareness of the musculoskeletal complications of HSCT and TBI.
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Affiliation(s)
- Taylor J Jackson
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sogol Mostoufi-Moab
- Department of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatric Endocrinology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christine Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naomi J Balamuth
- Department of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexandre Arkader
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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23
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Diet and exercise interventions for pediatric cancer patients during therapy: tipping the scales for better outcomes. Pediatr Res 2018; 83:50-56. [PMID: 29068433 PMCID: PMC5865395 DOI: 10.1038/pr.2017.225] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/31/2017] [Indexed: 12/20/2022]
Abstract
Obesity at diagnosis is a negative prognostic indicator for several pediatric cancers including acute leukemia and bone tumors. Incidence of obesity in children has increased three-fold over the past 2 decades, and causes for this include poor diet, excessive caloric intake, and lack of physical activity, which are collectively referred to as energy balance-related behaviors. Few energy balance interventions have been implemented in pediatric cancer patients during treatment, and here we will probe the rationale for pursuing such studies. The need to modify composition of calories consumed and to identify specific beneficial exercise regimens will be discussed, relative to weight reduction or management.
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24
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Inaba H, Cao X, Han AQ, Panetta JC, Ness KK, Metzger ML, Rubnitz JE, Ribeiro RC, Sandlund JT, Jeha S, Cheng C, Pui CH, Relling MV, Kaste SC. Bone mineral density in children with acute lymphoblastic leukemia. Cancer 2017; 124:1025-1035. [PMID: 29266176 DOI: 10.1002/cncr.31184] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Children with acute lymphoblastic leukemia (ALL) can develop reduced bone mineral density (BMD). However, data from patients who received treatment on a frontline regimen without cranial irradiation are limited, and no genome-wide analysis has been reported. METHODS Lumbar BMD was evaluated by quantitative computed tomography at diagnosis, after 120 weeks of continuation therapy, and after 2 years off therapy in pediatric patients with ALL (ages 2-18 years at diagnosis) who were treated on the St. Jude Total XV Protocol. Clinical, pharmacokinetic, and genetic risk factors associated with decreased BMD Z-scores were evaluated. RESULTS The median BMD Z-score in 363 patients was 0.06 at diagnosis, declined to -1.08 at week 120, but partly recovered to -0.72 after 2 years off therapy; BMD in patients with low BMD Z-scores at diagnosis remained low after therapy. Older age (≥10 years vs 2-9.9 years at diagnosis; P < .001), a higher BMD Z-score at diagnosis (P = .001), and a greater area under the plasma drug concentration-time curve for dexamethasone in weeks 7 and 8 of continuation therapy (P = .001) were associated with a greater decrease in BMD Z-score from diagnosis to week 120. Single-nucleotide polymorphisms in 2 genes important in osteogenesis and bone mineralization (COL11A1 [reference single-nucleotide polymorphism rs2622849]; P = 2.39 × 10-7 ] and NELL1 [rs11025915]; P = 4.07 × 10-6 ]) were associated with a decreased BMD Z-score. NELL1 (P = .003) also was associated with a greater dexamethasone area under the plasma drug concentration-time curve. CONCLUSIONS BMD Z-scores decreased during therapy, especially in patients who had clinical, pharmacokinetic, and genetic risk factors. Early recognition of BMD changes and strategies to optimize bone health are essential. Cancer 2018;124:1025-35. © 2017 American Cancer Society.
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Affiliation(s)
- Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Xueyuan Cao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Acute and Tertiary Care, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Alice Q Han
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John C Panetta
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Monika L Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jeffrey E Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Raul C Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John T Sandlund
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
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25
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Siegel DA, Claridy M, Mertens A, George E, Vangile K, Simoneaux SF, Meacham LR, Wasilewski-Masker K. Risk factors and surveillance for reduced bone mineral density in pediatric cancer survivors. Pediatr Blood Cancer 2017; 64. [PMID: 28233475 DOI: 10.1002/pbc.26488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pediatric cancer survivors are at increased risk of developing low bone mineral density (BMD) due to cancer treatment. This study assessed the yield of screening for low BMD in pediatric-aged cancer survivors as per the Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines, which recommend screening survivors who received steroids, methotrexate, or hematopoietic cell transplant (HCT). METHODS This is a retrospective cohort study of 475 pediatric blood cancer and noncentral nervous system solid tumor survivors screened for low BMD with dual-energy X-ray absorptiometry (DXA) as per the COG-LTFU Guidelines from 2003 to 2010. Risk factors for low BMD (DXA Z-score ≤-2) were evaluated by univariate and multivariate analysis. RESULTS The mean DXA Z-score was -0.1 for both whole body and lumbar spine measurements. Among at-risk survivors, 8.2% (39/475) had low BMD. Multivariate analysis of survivors with low BMD showed significant association with male gender (odds ratio [OR] 3.4, 95% confidence interval [CI], 1.3-9.0), exposure to total body irradiation (TBI), cranial, or craniospinal radiation (OR 5.2, 95% CI, 1.8-14.9), and gonadal dysfunction (OR 4.3, 95% CI, 1.4-13.0). Methotrexate exposure was not significantly associated with low BMD. Survivors receiving HCT had a reduced risk of low BMD (OR 0.2, 95% CI, 0.1-0.9). CONCLUSION The highest risk factors for low BMD were male gender, exposure to TBI, cranial, or craniospinal radiation, and gonadal dysfunction. Survivors receiving methotrexate or HCT therapy have the lowest risk for low BMD among those screened. Future studies should investigate risk of low BMD for survivors receiving HCT without radiation exposure.
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Affiliation(s)
- David A Siegel
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Mechelle Claridy
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Ann Mertens
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Elizabeth George
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Kristen Vangile
- IS&T, Business Intelligence, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Stephen F Simoneaux
- Department of Pediatrics, Emory University, Atlanta, Georgia.,Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University, Atlanta, Georgia
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26
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Mogil RJ, Kaste SC, Ferry RJ, Hudson MM, Mulrooney DA, Howell CR, Partin RE, Srivastava DK, Robison LL, Ness KK. Effect of Low-Magnitude, High-Frequency Mechanical Stimulation on BMD Among Young Childhood Cancer Survivors: A Randomized Clinical Trial. JAMA Oncol 2017; 2:908-14. [PMID: 26967465 DOI: 10.1001/jamaoncol.2015.6557] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Bone accrual during youth is critical to establish sufficient strength for lifelong skeletal health. Children with cancer may develop low bone mineral density (BMD) any time before or after diagnosis. OBJECTIVE To evaluate the ability of low-magnitude, high-frequency mechanical stimulation to enhance BMD among childhood cancer survivors. DESIGN, SETTING, AND PARTICIPANTS Double-blind randomized clinical trial conducted at St Jude Children's Research Hospital from June 1, 2010, to January 22, 2013, using cancer survivors, ages 7 to 17 years, who were previously treated at St Jude Children's Research Hospital, were in remission, and at least 5 years from diagnosis, with whole-body or lumbar spine BMD z scores of -1.0 or lower. Participants were randomized (stratified by sex and Tanner stage) to either a placebo device or low-magnitude, high-frequency mechanical stimulation device, which was used at home. INTERVENTIONS Placebo or low-magnitude, high-frequency mechanical stimulation (0.3 g; 32-37 Hz) for 2 sessions lasting 10 minutes each, 7 days per week for 1 year. All participants were prescribed daily cholecalciferol (vitamin D) and calcium. MAIN OUTCOMES AND MEASURES Changes in areal and volumetric BMD and bone biomarkers were compared by analysis of variance, adjusted for strata. RESULTS Of the 65 participants, 32 were randomized to the intervention group (mean [SD] age was 13.6 [3.7] years, 18 [56.2%] were male, and 27 [84.4%] were white), and 33 were randomized to the placebo group (mean [SD] age was 13.6 [2.9] years, 17 [51.5%] were male, and 26 [78.8%] were white). Forty-eight participants completed the trial, 22 in the intervention group and 26 in the placebo group with median adherence of 70.1% for intervention and 63.7% for placebo groups. With intention-to-treat analysis, mean (SD) whole-body BMD z score by dual x-ray absorptiometry improved by 0.25 (0.78) in the intervention (n = 22), but decreased by -0.19 (0.79) in the placebo group (n = 26, P = .05). Circulating osteocalcin at 12 months correlated with change in total body BMD (r = 0.35, P = .02). Tibial trabecular bone among participants completing 70% or more of the prescribed sessions increased by a mean of 11.2% (95% CI, 5.2 to 17.2%) compared with those completing less than 70% who decreased by a mean of -1.3% (95% CI, -7.3 to 4.7%; P = .02). Change in circulating receptor activator of nuclear factor κ-B ligand was higher in the intervention than in the placebo group (0.06 [0.16] vs -0.04 [0.17] pmol/L) (P = .04). CONCLUSIONS AND RELEVANCE Pediatric cancer survivors with low BMD may benefit from low-magnitude, high-frequency mechanical stimulation as a novel and safe intervention to optimize peak bone mass during youth, alone or in conjunction with other therapies. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01010230.
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Affiliation(s)
- Rona J Mogil
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Sue C Kaste
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee3Department of Radiology, University of Tennessee Health Science Center, Memphis
| | - Robert J Ferry
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis5Department of Psychology, University of Memphis, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Deo K Srivastava
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee8Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
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27
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Abstract
PURPOSE OF REVIEW Childhood cancer survivors experience excessive weight gain early in treatment. Lifestyle interventions need to be initiated early in cancer care to prevent the early onset of obesity and cardiovascular disease (CVD). We reviewed the existing literature on early lifestyle interventions in childhood cancer survivors and consider implications for clinical care. RECENT FINDINGS Few lifestyle interventions focus on improving nutrition in childhood cancer survivors. A consistent effect on reducing obesity and CVD risk factors is not evident from the limited number of studies with heterogeneous intervention characteristics, although interventions with a longer duration and follow-up show more promising trends. Future lifestyle interventions should be of a longer duration and include a nutrition component. Interventions with a longer duration and follow-up are needed to assess the timing and sustainability of the intervention effect. Lifestyle interventions introduced early in cancer care are both safe and feasible.
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Affiliation(s)
- Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
| | - Michael J Kelly
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
- Division of Pediatric Hematology and Oncology, The Floating Hospital for Children, Tufts Medical Center, Boston, MA, USA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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28
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Lee AW, Romanowski GL, Proudfoot JA, Kuo DJ. Effect of Vitamin D Supplementation on Delayed Hyperphosphatemia in Pediatric Acute Lymphoblastic Leukemia Patients During Induction Chemotherapy. J Pediatr Pharmacol Ther 2017; 22:102-105. [PMID: 28469534 DOI: 10.5863/1551-6776-22.2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Vitamin D plays a role in maintaining bone health and calcium metabolism, but recent studies cast doubt on vitamin D supplementation's benefits in survivors of acute lymphoblastic leukemia (ALL). Vitamin D supplementation could increase serum phosphate through increased intestinal absorption of phosphate and suppression of parathyroid hormone, which would lead to decreased renal phosphate excretion. Because of the potential for renal injury during induction chemotherapy for ALL, Vitamin D supplementation's potential for increasing hyperphosphatemia could outweigh its suggested but unproven benefits. METHODS To measure the interaction between vitamin D supplementation and phosphate during chemotherapy induction, a retrospective study was done. Demographic data; clinical information about the diagnosis; laboratory data regarding calcium, phosphate, and vitamin D concentrations; and medication histories were reviewed. RESULTS A retrospective study of 41 children with ALL showed no statistically significant difference in the final phosphate concentrations that were obtained (4.41 mg/dL vs. 4.53 mg/dL, p = 0.635) with regard to their vitamin D supplementation status. Longitudinal effects with vitamin D and phosphate showed a trend toward increasing phosphate concentrations in patients who received supplemental vitamin D (0.035 vs. 0.010 mg/dL per day; p = 0.102). CONCLUSIONS Vitamin D potentially poses a risk of hyperphosphatemia in children undergoing induction chemotherapy for ALL.
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29
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The Association of Oral Vitamin D and Calcium Supplementation With Bone Mineral Density in Pediatric Acute Lymphoblastic Leukemia Patients. J Pediatr Hematol Oncol 2017; 39:287-292. [PMID: 28234736 DOI: 10.1097/mph.0000000000000797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To investigate the association of calcium (Ca) and vitamin D (vit D) supplementation with bone mineral density (BMD) in pediatric acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS Group I (n=11): de novo ALL patients aged 1 to 18 years. Group II (n=46): pediatric ALL survivors in first complete remission and ALL patients on maintenance chemotherapy. We stratified group II into 3 subgroups according to the postdiagnosis period (group IIa: 8 to 24 mo, group IIb: 24 to 48 mo, group IIc: >48 mo). Group III (n=22): healthy siblings of group II. Daily oral vit D3 and Ca carbonate was given only to group I. In group I, BMD was measured at diagnosis and after completion of intensive chemotherapy (TP1 and TP2). RESULTS A significant increase in Ca (P=0.024) and 25-OH vit D (P=0.01), and a decrease in magnesium (P=0.023) were detected at TP2 compared with TP1 in group I. Mean plasma levels of 25-OH vit D were <20 ng/mL in all the groups. Total body (P=0.005), total body less head (P=0.005), and L1 to L4 BMD Z scores (P=0.025) decreased significantly at TP2 compared with TP1. The lowest BMD scores were found at 8 to 24 months after diagnosis in unsupplemented patients. A gradual increase in BMD Z scores was shown, with the highest scores in group IIc. CONCLUSION Vit D and Ca supplementation in pediatric ALL patients during intensive chemotherapy may not prevent bone mineral loss. BMD scores of pediatric ALL patients described by other studies, as a major decrease in the first 2 years and gradual increase afterward, was also observed in our patients.
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30
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Siviero-Miachon AA, Spinola-Castro AM, de Martino Lee ML, Calixto AR, Geloneze B, Lazaretti-Castro M, Guerra-Junior G. Visfatin is a positive predictor of bone mineral density in young survivors of acute lymphocytic leukemia. J Bone Miner Metab 2017; 35:73-82. [PMID: 26661660 DOI: 10.1007/s00774-015-0728-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 11/18/2015] [Indexed: 12/18/2022]
Abstract
Bone mass acquisition may be compromised in survivors of childhood acute lymphocytic leukemia due to various factors, including adiposity. Fat accumulation can affect bone through the direct effect of adipokines or indirectly through the state of chronic inflammation. The aim of this study was to evaluate the effect of body composition and adipokines on bone mass in survivors of acute lymphocytic leukemia. This was a cross-sectional study of 56 survivors aged between 15 and 24 years, 44.6 % of whom received cranial radiotherapy (18-24 Gy), assessed according to body fat, lean mass, and bone mineral density (dual energy X-ray absorptiometry), computed tomography scan-derived abdominal adipose tissue, and adipokines by a multiple regression analysis. Both lumbar spine L1-L4 (trabecular bone) and total body (cortical bone) bone mineral density were positively correlated with visfatin (p < 0.050). Lean mass index was positively correlated, while waist-to-height ratio was negatively correlated with cortical bone (p < 0.010). Low bone mineral density for chronological age was detected in 5.4 % of patients in total body, and 8.9 % at the lumbar spine. In survivors of acute lymphocytic leukemia, visfatin may play an important role in the complex relationship between body composition and bone. At present, visfatin may represent a model for further study of bone metabolism, and could possibly explain the unknown mechanisms linking bone metabolism and cancer.
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Affiliation(s)
- Adriana Aparecida Siviero-Miachon
- Division of Pediatric Endocrinology, Department of Pediatrics, Federal University of Sao Paulo-UNIFESP/EPM, 307 Doutor Diogo de Faria Street, Sao Paulo, 04037-000, Brazil
- Pediatric Oncology Institute-IOP/GRAACC, UNIFESP/EPM, 743 Botucatu Street, Sao Paulo, 04023-062, Brazil
| | - Angela Maria Spinola-Castro
- Division of Pediatric Endocrinology, Department of Pediatrics, Federal University of Sao Paulo-UNIFESP/EPM, 307 Doutor Diogo de Faria Street, Sao Paulo, 04037-000, Brazil.
- Pediatric Oncology Institute-IOP/GRAACC, UNIFESP/EPM, 743 Botucatu Street, Sao Paulo, 04023-062, Brazil.
| | | | - Antonio Ramos Calixto
- Laboratory of Investigation on Metabolism and Diabetes-LIMED, Faculty of Medical Sciences, State University of Campinas-UNICAMP, 420 Carlos Chagas Street, Campinas, 13083-878, Brazil
| | - Bruno Geloneze
- Laboratory of Investigation on Metabolism and Diabetes-LIMED, Faculty of Medical Sciences, State University of Campinas-UNICAMP, 420 Carlos Chagas Street, Campinas, 13083-878, Brazil
| | - Marise Lazaretti-Castro
- Division of Endocrinology and Metabolism, Department of Medicine, Federal University of Sao Paulo-UNIFESP/EPM, 910 Pedro de Toledo Street, Sao Paulo, 04039-032, Brazil
| | - Gil Guerra-Junior
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas-UNICAMP, "Zeferino Vaz" University City, 126 Tessalia Vieira de Camargo Street, Campinas, 13083-887, Brazil
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31
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Abstract
BACKGROUND Childhood cancer survivors are at a higher risk of developing health conditions such as osteoporosis, and cardiovascular disease than their peers. Health-promoting behaviour, such as consuming a healthy diet, could lessen the impact of these chronic issues, yet the prevalence rate of health-protecting behaviour amongst survivors of childhood cancer is similar to that of the general population. Targeted nutritional interventions may prevent or reduce the incidence of these chronic diseases. OBJECTIVES The primary aim of this review was to assess the efficacy of a range of nutritional interventions designed to improve the nutritional intake of childhood cancer survivors, as compared to a control group of childhood cancer survivors who did not receive the intervention. Secondary objectives were to assess metabolic and cardiovascular risk factors, measures of weight and body fat distribution, behavioural change, changes in knowledge regarding disease risk and nutritional intake, participants' views of the intervention, measures of health status and quality of life, measures of harm associated with the process or outcomes of the intervention, and cost-effectiveness of the intervention SEARCH METHODS We searched the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL; 2013, Issue 3), MEDLINE/PubMed (from 1945 to April 2013), and Embase/Ovid (from 1980 to April 2013). We ran the search again in August 2015; we have not yet fully assessed these results, but we have identified one ongoing trial. We conducted additional searching of ongoing trial registers - the International Standard Randomised Controlled Trial Number register and the National Institutes of Health register (both screened in the first half of 2013) - reference lists of relevant articles and reviews, and conference proceedings of the International Society for Paediatric Oncology and the International Conference on Long-Term Complications of Treatment of Children and Adolescents for Cancer (both 2008 to 2012). SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared the effects of a nutritional intervention with a control group which did not receive the intervention in this review. Participants were childhood cancer survivors of any age, diagnosed with any type of cancer when less than 18 years of age. Participating childhood cancer survivors had completed their treatment with curative intent prior to the intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected and extracted data from each identified study, using a standardised form. We assessed the validity of each identified study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We used the GRADE criteria to assess the quality of each trial. MAIN RESULTS Three RCTs were eligible for review. A total of 616 participants were included in the analysis. One study included participants who had been treated for acute lymphoblastic leukaemia (ALL) (275 participants). Two studies included participants who had all forms of paediatric malignancies (266 and 75 participants). All participants were less than 21 years of age at study entry. The follow-up ranged from one month to 36 months from the initial assessment. All intended outcomes were not evaluated by each included study. All studies looked at different interventions, and so we were unable to pool results. We could not rule out the presence of bias in any of the studies.There was no clear evidence of a difference in calcium intake at one month between those who received the single, half-day, group-based education that focused on bone health, and those who received standard care (mean difference (MD) 111.60, 95% confidence interval (CI) -258.97 to 482.17; P = 0.56, low quality evidence). A regression analysis, adjusting for baseline calcium intake and changes in knowledge and self-efficacy, showed a significantly greater calcium intake for the intervention as compared with the control group at the one-month follow-up (beta coefficient 4.92, 95% CI 0.33 to 9.52; P = 0.04). There was statistically significant higher, self-reported milk consumption (MD 0.43, 95% CI 0.07 to 0.79; P = 0.02, low quality evidence), number of days on calcium supplementation (MD 11.42, 95% CI 7.11 to 15.73; P < 0.00001, low quality evidence), and use of any calcium supplementation (risk ratio (RR) 3.35, 95% CI 1.86 to 6.04; P < 0.0001, low quality evidence), with those who received this single, face-to-face, group-based, health behaviour session.There was no clear evidence of a difference in bone density Z-scores measured with a dual-energy X-ray absorptiometry (DEXA) scan at 36 months follow-up (MD -0.05, 95% CI -0.26 to 0.16; P = 0.64, moderate quality evidence) between those who received calcium and vitamin D supplementation combined with nutrition education and those who received nutrition education alone. There was also no clear evidence of a difference in bone mineral density between the intervention and the control group at the 12-month (median difference -0.17, P = 0.99) and 24-month follow-up (median difference -0.04, P = 0.54).A single multi-component health behaviour change intervention, focusing on general healthy eating principles, with two telephone follow-ups brought about a 0.17 lower score on the four-point Likert scale of self-reported junk food intake compared with the control group (MD -0.17, 95% CI -0.33 to -0.01; P = 0.04, low quality evidence); this result was statistically significant. There was no clear evidence of a difference between the groups in the self-reported use of nutrition as a health protective behaviour (MD -0.05, 95% CI -0.24 to 0.14; P = 0.60, low quality evidence). AUTHORS' CONCLUSIONS Due to a paucity of studies, and the heterogeneity of the studies included in this review, we are unable to draw conclusions regarding the effectiveness of nutritional interventions for use with childhood cancer survivors. Although there is low quality evidence for the improvement in health behaviours using health behaviour change interventions, there remains no evidence as to whether this translates into an improvement in dietary intake. There was also no evidence that the studies reduced the risk of cardiovascular and metabolic disorders in childhood cancer survivors, although no evidence of effect is not the same as evidence of no effect. This review highlights the need for further well designed trials to be implemented in this population.
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Affiliation(s)
- Jennifer E Cohen
- Kids Cancer Centre, Sydney Children’s HospitalDepartment of Nutrition and DieteticsRandwick NSWAustralia
- School of Women’s and Children’s HealthDiscipline of PaediatricsRandwick NSWAustralia
- University of WollongongSchool of MedicineWollongongNSWAustralia
| | - Claire E Wakefield
- School of Women’s and Children’s HealthDiscipline of PaediatricsRandwick NSWAustralia
- Kids Cancer Centre, Sydney Children's HospitalRandwick NSWAustralia
| | - Richard J Cohn
- School of Women’s and Children’s HealthDiscipline of PaediatricsRandwick NSWAustralia
- Kids Cancer Centre, Sydney Children's HospitalRandwick NSWAustralia
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Abstract
This article reviews the manifestations and risk factors associated with osteoporosis in childhood, the definition of osteoporosis and recommendations for monitoring and prevention. As well, this article discusses when a child should be considered a candidate for osteoporosis therapy, which agents should be prescribed, duration of therapy and side effects. There has been significant progress in our understanding of risk factors and the natural history of osteoporosis in children over the past number of years. This knowledge has fostered the development of logical approaches to the diagnosis, monitoring, and optimal timing of osteoporosis intervention in this setting. Current management strategies are predicated upon monitoring at-risk children to identify and then treat earlier rather than later signs of osteoporosis in those with limited potential for spontaneous recovery. On the other hand, trials addressing the prevention of the first-ever fracture are still needed for children who have both a high likelihood of developing fractures and less potential for recovery. This review focuses on the evidence that shapes the current approach to diagnosis, monitoring, and treatment of osteoporosis in childhood, with emphasis on the key pediatric-specific biological principles that are pivotal to the overall approach and on the main questions with which clinicians struggle on a daily basis. The scope of this article is to review the manifestations of and risk factors for primary and secondary osteoporosis in children, to discuss the definition of pediatric osteoporosis, and to summarize recommendations for monitoring and prevention of bone fragility. As well, this article reviews when a child is a candidate for osteoporosis therapy, which agents and doses should be prescribed, the duration of therapy, how the response to therapy is adjudicated, and the short- and long-term side effects. With this information, the bone health clinician will be poised to diagnose osteoporosis in children and to identify when children need osteoporosis therapy and the clinical outcomes that gauge efficacy and safety of treatment.
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Affiliation(s)
- L M Ward
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada.
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
| | - V N Konji
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
| | - J Ma
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Revuelta Iniesta R, Rush R, Paciarotti I, Rhatigan EB, Brougham FHM, McKenzie JM, Wilson DC. Systematic review and meta-analysis: Prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients. Clin Nutr 2016; 35:95-108. [PMID: 25638403 DOI: 10.1016/j.clnu.2014.12.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Vitamin D inadequacy is now an internationally recognized health problem and pediatric cancer patients may be at even higher risk than healthy children. We aimed to evaluate primary research to establish the prevalence of vitamin D inadequacy and to explore its possible causes in pediatric cancer patients. METHODS Electronic databases were searched (no restriction-Aug 2013) with no language restrictions and keywords related to cancer and vitamin D. We included studies of patients aged <18 years, diagnosed with and treated for cancer and reporting plasma vitamin D status. Evidence was critically appraised employing the CASP tool. Meta-analysis was performed when appropriate. RESULTS We included 19 studies, which were mainly of moderate-quality and heterogeneous in the definitions of vitamin D deficiency and insufficiency. The median (range) prevalence of vitamin D deficiency was 14% (0-61.5%) and insufficiency 23% (0-83%). Finally, a significant effect of younger age with vitamin D inadequacy was shown (effect size: -0.132; 95%CI -0.203, -0.060). CONCLUSION There is a possibility of a high prevalence of vitamin D inadequacy in pediatric cancer patients, especially older children, urging the need for high-quality population-based longitudinal studies using standard definitions.
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Affiliation(s)
- R Revuelta Iniesta
- Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, UK; Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.
| | - R Rush
- Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, UK
| | - I Paciarotti
- Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, UK; Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - E B Rhatigan
- Department of Paediatrics, Victoria Hospital, Kirkcaldy, Fife, UK
| | - F H M Brougham
- Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - J M McKenzie
- Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, UK
| | - D C Wilson
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, Liu S, Looker AC, Wallace TC, Wang DD. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int 2016; 27:367-76. [PMID: 26510847 PMCID: PMC4715837 DOI: 10.1007/s00198-015-3386-5] [Citation(s) in RCA: 309] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/22/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED The aim was to meta-analyze randomized controlled trials of calcium plus vitamin D supplementation and fracture prevention. Meta-analysis showed a significant 15 % reduced risk of total fractures (summary relative risk estimate [SRRE], 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87). INTRODUCTION Calcium plus vitamin D supplementation has been widely recommended to prevent osteoporosis and subsequent fractures; however, considerable controversy exists regarding the association of such supplementation and fracture risk. The aim was to conduct a meta-analysis of randomized controlled trials [RCTs] of calcium plus vitamin D supplementation and fracture prevention in adults. METHODS A PubMed literature search was conducted for the period from July 1, 2011 through July 31, 2015. RCTs reporting the effect of calcium plus vitamin D supplementation on fracture incidence were selected from English-language studies. Qualitative and quantitative information was extracted; random-effects meta-analyses were conducted to generate summary relative risk estimates (SRREs) for total and hip fractures. Statistical heterogeneity was assessed using Cochran's Q test and the I (2) statistic, and potential for publication bias was assessed. RESULTS Of the citations retrieved, eight studies including 30,970 participants met criteria for inclusion in the primary analysis, reporting 195 hip fractures and 2231 total fractures. Meta-analysis of all studies showed that calcium plus vitamin D supplementation produced a statistically significant 15 % reduced risk of total fractures (SRRE, 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87). Numerous sensitivity and subgroup analyses produced similar summary associations. A limitation is that this study utilized data from subgroup analysis of the Women's Health Initiative. CONCLUSIONS This meta-analysis of RCTs supports the use of calcium plus vitamin D supplements as an intervention for fracture risk reduction in both community-dwelling and institutionalized middle-aged to older adults.
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Affiliation(s)
- C M Weaver
- Department of Nutrition Science, Women's Global Health Institute, Purdue University, West Lafayette, IN, USA
| | | | - C J Boushey
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Bone Metabolism Laboratory, Tufts University, Boston, MA, USA
| | - J M Lappe
- School of Nursing, Creighton University, Omaha, NE, USA
- School of Medicine, Creighton University, Omaha, NE, USA
| | - M S LeBoff
- Skeletal Health and Osteoporosis Center and Bone Density Unit, Calcium and Bone Section, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Liu
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - A C Looker
- Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - T C Wallace
- National Osteoporosis Foundation, 1150 17th Street NW, Suite 850, Washington, DC, 20036, USA.
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA.
| | - D D Wang
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
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Cummings EA, Ma J, Fernandez CV, Halton J, Alos N, Miettunen PM, Jaremko JL, Ho J, Shenouda N, Matzinger MA, Lentle B, Stephure D, Stein R, Sbrocchi AM, Rodd C, Lang B, Israels S, Grant RM, Couch R, Barr R, Hay J, Rauch F, Siminoski K, Ward LM. Incident Vertebral Fractures in Children With Leukemia During the Four Years Following Diagnosis. J Clin Endocrinol Metab 2015; 100:3408-17. [PMID: 26171800 PMCID: PMC4909472 DOI: 10.1210/jc.2015-2176] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purpose of this article was to determine the incidence and predictors of vertebral fractures (VF) during the 4 years after diagnosis in pediatric acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS Children were enrolled within 30 days of chemotherapy initiation, with incident VF assessed annually on lateral spine radiographs according to the Genant method. Extended Cox models were used to assess the association between incident VF and clinical predictors. RESULTS A total of 186 children with ALL completed the baseline evaluation (median age, 5.3 years; interquartile range, 3.4-9.7 years; 58% boys). The VF incidence rate was 8.7 per 100 person-years, with a 4-year cumulative incidence of 26.4%. The highest annual incidence occurred at 12 months (16.1%; 95% confidence interval [CI], 11.2-22.7), falling to 2.9% at 4 years (95% CI, 1.1-7.3). Half of the children with incident VF had a moderate or severe VF, and 39% of those with incident VF were asymptomatic. Every 10 mg/m(2) increase in average daily glucocorticoid dose (prednisone equivalents) was associated with a 5.9-fold increased VF risk (95% CI, 3.0-11.8; P < .01). Other predictors of increased VF risk included VF at diagnosis, younger age, and lower spine bone mineral density Z-scores at baseline and each annual assessment. CONCLUSIONS One quarter of children with ALL developed incident VF in the 4 years after diagnosis; most of the VF burden was in the first year. Over one third of children with incident VF were asymptomatic. Discrete clinical predictors of a VF were evident early in the patient's clinical course, including a VF at diagnosis.
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Affiliation(s)
- Elizabeth A Cummings
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Jinhui Ma
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Conrad V Fernandez
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Jacqueline Halton
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Nathalie Alos
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Paivi M Miettunen
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Jacob L Jaremko
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Josephine Ho
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Nazih Shenouda
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Mary Ann Matzinger
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Brian Lentle
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - David Stephure
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Robert Stein
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Ann Marie Sbrocchi
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Celia Rodd
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Bianca Lang
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Sara Israels
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Ronald M Grant
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Robert Couch
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Ronald Barr
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - John Hay
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Frank Rauch
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Kerry Siminoski
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Leanne M Ward
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
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36
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Abstract
Skeletal abnormalities are commonly seen in children and adolescents with leukemia. The spectrum ranges from mild pain to debilitating osteonecrosis (ON) and fractures. In this review, we summarize the skeletal manifestations, provide an update on therapeutic strategies for prevention and treatment, and discuss the most recent advances in musculoskeletal research. Early recognition of skeletal abnormalities and strategies to optimize bone health are essential to prevent long-term skeletal sequelae and diminished quality of life observed in children and adolescents with leukemia.
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Affiliation(s)
- Sogol Mostoufi-Moab
- Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 USA
| | - Jacqueline Halton
- Department of Pediatrics, The Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario Canada K1H8L1
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37
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Watsky MA, Carbone LD, An Q, Cheng C, Lovorn EA, Hudson MM, Pui CH, Kaste SC. Bone turnover in long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2014; 61:1451-6. [PMID: 24648266 PMCID: PMC4625912 DOI: 10.1002/pbc.25025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/12/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND We investigated the effects of demographic, lifestyle (self-reported smoking status and physical activity levels), cancer-related treatment factors (radiation and chemotherapy), and diet (calcium and vitamin D intake) on bone turnover and the relationship of bone turnover to lumbar spine bone mineral density (BMD) Z-scores (LS-BMD Z-scores) determined by quantitative computed tomography (QCT) in 418 ≥5-year survivors of childhood acute lymphoblastic leukemia (ALL). PROCEDURE Bone turnover was assessed by biomarkers including serum bone-specific alkaline phosphatase (BALP), osteocalcin (OC), and urinary N-telopeptide of type I collagen indexed to creatinine (NTX/Cr). The 215 males ranged in age from 9 to 36 years (median age 17 years). RESULTS Age and tanner score were inversely associated with all biomarkers (BALP, OC, NTX/Cr) (P < 0.001). Males had higher BALP and OC than females (P < 0.001). Body mass index (BMI) was inversely associated with OC and NTX/Cr (P < 0.001). There was no significant association of biomarkers with lifestyle related factors, ALL treatment-related factors, dietary calcium, vitamin D, or LS-BMD Z-score. CONCLUSIONS In this population of long-term survivors of ALL, bone turnover was significantly associated with age, gender, tanner stage, and BMI. ALL-related treatments did not influence bone turnover and bone turnover was not predictive of volumetric LS-BMD Z-score.
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Affiliation(s)
| | - Laura D. Carbone
- Department of Medicine, Georgia Regents University, Augusta, Ga, USA
| | - Qi An
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Elizabeth A. Lovorn
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M. Hudson
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sue C. Kaste
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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