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CC BY-NC-ND 4.0 · South Asian J Cancer 2021; 10(03): 183-186
DOI: 10.1055/s-0041-1733468
Original Article: Pediatric Oncology

Alterations in Bone Turnover during Chemotherapy in Children with Acute Lymphoblastic Leukemia

Vineeta Gupta
1   Division of Pediatric Hematology Oncology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Shalini Dash
1   Division of Pediatric Hematology Oncology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Priyanka Aggarwal
1   Division of Pediatric Hematology Oncology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Surya Kumar Singh
2   Department of Endocrinology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Abstract

Background Disturbances of bone metabolism frequently occur in children with acute lymphoblastic leukemia (ALL), leading to increased risk of osteopenia and osteoporosis at diagnosis, during and after completion of chemotherapy. The present study was performed to evaluate alteration in bone mineral metabolism in children with ALL during chemotherapy.

Method Fifty newly diagnosed patients with ALL in the age group of 2 to 14 years were included. Relapsed and refractory cases were excluded. Enrolled children were stratified into standard and high risk according to National Cancer Institute criteria. Quantitative analysis of bone resorptive marker carboxyl-terminal telopeptide of human type 1 collagen (ICTP) was assessed at baseline and 3 months after chemotherapy by the sandwich enzyme-linked immunosorbent assay technique.

Results Of 50 patients enrolled, 21 were standard and 29 were high risk. The mean age was 7.75 ± 4.0 years and the male-to-female ratio was 3.5:1. ICTP levels were analyzed in 44 patients, of which 37 (84%) showed significantly increased levels. The mean ICTP level in patients at diagnosis and controls was 1.78 ± 1.39 and 0.96 ± 0.32 µg/L, respectively (p = 0.001). The mean ICTP level at 3 months after chemotherapy increased to 3.55 ± 1.40 µg/L (p = 0.000). It was significantly increased in males (p = 0.000) and in B cell ALL group (p = 0.000) in comparison to females and T cell group. Both standard and high risk groups were equally affected (p = 0.000). On multivariate analysis, no single risk factor could be identified.

Conclusion The marker of bone resorption (ICTP) in children with ALL was increased at diagnosis, which further increased during chemotherapy. The disease itself and the intensive chemotherapy both contributed to the increased levels.

Keywords

skeletal morbidity - acute lymphoblastic leukemia - bone metabolism - carboxyl-terminal telopeptide of human type 1 collagen (ICTP) - quality of life


Publication History

Article published online:
20 December 2021

© 2021. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Haddy TB, Mosher RB, Reaman GH. Osteoporosis in survivors of acute lymphoblastic leukemia. Oncologist 2001; 6 (03) 278-285
    CrossrefPubMedGoogle Scholar
  • 2 Kaushik A, Bansal D, Khandelwal N, Trehan A, Marwaha RK. Changes in bone mineral density during therapy in childhood acute lymphoblastic leukemia. Indian Pediatr 2009; 46 (03) 245-248
    PubMedGoogle Scholar
  • 3 Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am 1970; 52 (03) 457-467
    CrossrefPubMedGoogle Scholar
  • 4 Vitanza NA, Hogan LE, Zhang G, Parker RI. The progress of bone mineral density abnormalities after chemotherapy for childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2015; 37 (05) 356-361
    CrossrefPubMedGoogle Scholar
  • 5 Kaste SC, Jones-Wallace D, Rose SR. et al Bone mineral decrements in survivors of childhood acute lymphoblastic leukemia: frequency of occurrence and risk factors for their development. Leukemia 2001; 15 (05) 728-734
    CrossrefPubMedGoogle Scholar
  • 6 Crofton PM, Wade JC, Taylor MR, Holland CV. Serum concentrations of carboxyl-terminal propeptide of type I procollagen, amino-terminal propeptide of type III procollagen, cross-linked carboxyl-terminal telopeptide of type I collagen, and their interrelationships in schoolchildren. Clin Chem 1997; 43 (09) 1577-1581
    CrossrefPubMedGoogle Scholar
  • 7 Arikoski P, Komulainen J, Riikonen P, Voutilainen R, Knip M, Kröger H. Alterations in bone turnover and impaired development of bone mineral density in newly diagnosed children with cancer: a 1-year prospective study. J Clin Endocrinol Metab 1999; 84 (09) 3174-3181
    CrossrefPubMedGoogle Scholar
  • 8 van der Sluis IM, van den Heuvel-Eibrink MM, Hählen K, Krenning EP, de Muinck Keizer-Schrama SM. Altered bone mineral density and body composition, and increased fracture risk in childhood acute lymphoblastic leukemia. J Pediatr 2002; 141 (02) 204-210
    CrossrefPubMedGoogle Scholar
  • 9 Crofton PM, Ahmed SF, Wade JC. et al Bone turnover and growth during and after continuing chemotherapy in children with acute lymphoblastic leukemia. Pediatr Res 2000; 48 (04) 490-496
    CrossrefPubMedGoogle Scholar
  • 10 Calvo MS, Eyre DR, Gundberg CM. Molecular basis and clinical application of biological markers of bone turnover. Endocr Rev 1996; 17 (04) 333-368
    PubMedGoogle Scholar
  • 11 Pater A, Mańkowska-Cyl A, Siódmiak J, Jatczak-Gaca A, Kurylak A, Sypniewska G. Biomarkers of bone cell activity in children and adolescents with newly diagnosed untreated acute lymphoblastic leukemia. Med Res J 2016; 1: 43-47
    CrossrefGoogle Scholar
  • 12 Halton JM, Atkinson SA, Fraher L. et al Altered mineral metabolism and bone mass in children during treatment for acute lymphoblastic leukemia. J Bone Miner Res 1996; 11 (11) 1774-1783
    CrossrefPubMedGoogle Scholar
  • 13 Tragiannidis A, Dokos Ch, Sidi V. et al Alterations of bone mineral metabolism of children with different cell lineage types of acute lymphoblastic leukaemia under chemotherapy. Hippokratia 2011; 15 (01) 43-47
    PubMedGoogle Scholar
  • 14 Atkinson SA, Halton JM, Bradley C, Wu B, Barr RD. Bone and mineral abnormalities in childhood acute lymphoblastic leukemia: influence of disease, drugs and nutrition. Int J Cancer Suppl 1998; 11: 35-39
    CrossrefPubMedGoogle Scholar