ASSESSMENT OF THE LATE EFFECTS ON BONES AND ON BODY COMPOSITION OF CHILDREN AND ADOLESCENTS TREATED FOR ACUTE LYMPHOCYTIC LEUKEMIA ACCORDING TO BRAZILIAN PROTOCOLS

• Published in: Revista paulista de pediatria Vol. 35; no. 1; pp. 78 - 85
• Main Authors: Molinari, Poliana Cristina Carmona, Lederman, Henrique Manoel, Lee, Maria Lucia de Martino, Caran, Eliana Maria Monteiro
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Sociedade de Pediatria de São Paulo 01-01-2017
• Subjects: Adolescent; Antineoplastic Agents - adverse effects; Antineoplastic Protocols; Body Composition - drug effects; Body Composition - radiation effects; Bone Density - drug effects; Bone Density - radiation effects; Brazil; Cross-Sectional Studies; Female; Humans; Male; Original; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - radiotherapy; Radiotherapy - adverse effects; Retrospective Studies; Time Factors
• ISSN: 0103-0582; 1984-0462
• DOI: 10.1590/1984-0462/;2017;35;1;00005

To evaluate the impact of therapy on bone mineral density (BMD) and body composition in survivors of acute lymphoblastic leukemia (ALL) treated in accordance with Brazilian protocols by the Brazilian Cooperative Group of Treatment of Lymphoblastic Leukemia in Childhood (GBTLI) LLA-93 and LLA-99.
A cross-sectional study with 101 patients was performed. BMD and body composition were evaluated using bone densitometry and were interpreted according to the age group and the reference population. Values between -1.1 and -1.9 in the group of children under 20 years were considered as risk group for low BMD z-scores. BMD values were compared to clinical characteristics, treatment received and body composition. A chi-square test, Fisher's exact test, likelihood ratio and Student's t-test were applied, with a 5% significance level.
The patients presented a frequency of fractures of 2%, of osteonecrosis, 2%, and of low BMD, 2.9%. In the group of 79 patients under 20 years of age, three had low BMD. The 16 that presented risk for low BMD, demonstrated lower valutes in lumbar vertebrae L1-L4 (p=0.01) and whole body (p=0.005), and smaller values of lean body mass (p=0.03). In the group of 22 patients over 20 years of age, ten had osteopenia.
The low impact of treatment on BMD of this study confirms the concept that the bone mass gain occurs with increasing age and that the treatment does not influence the process. The population at risk for low BMD values presented lower bone mass values and could benefit from a long-term monitoring for possible bone toxicity.