Impact of Vertebral Fractures and Glucocorticoid Exposure on Height Deficits in Children During Treatment of Leukemia.

Journal: The Journal Of Clinical Endocrinology And Metabolism
Treatment Used: Glucocorticoids
Number of Patients: 160
Published:
MediFind Summary

Summary: This study assessed the effect of vertebral fractures (VF) and glucocorticoid (GC) exposure on height deficits in children during treatment of acute lymphoblastic leukemia (ALL).

Conclusion: Glucocorticoid likely plays a major role in the observed height decline during therapy for acute lymphoblastic leukemia. Because only a minority of children had vertebral fractures, fractures could not have contributed significantly to the height deficit in the entire cohort but may have been important among the subset with vertebral fractures.

Abstract

Objective: To assess the effect of vertebral fractures (VF) and glucocorticoid (GC) exposure on height deficits in children during treatment of acute lymphoblastic leukemia (ALL).

Methods: Children with ALL treated without cranial radiation therapy (n = 160; median age, 5.1 years; 58.1% male) were followed prospectively for 6 years. Spinal deformity index (SDI) was used to quantify VF status.

Results: Baseline height z score ± SD was 0.3 ± 1.2. It fell by 0.5 ± 0.4 in the first 6 months for boys and by 0.4 ± 0.4 in the first 12 months for girls (P < 0.01 for both) and then subsequently recovered. The prevalence of VF peaked at 1 year (17.6%). Among those with VF, median SDI rose from 2 [interquartile range (IQR): 1, 7] at baseline to 8 (IQR: 1, 8) at 1 year. A mixed model for repeated measures showed that height z score declined by 0.13 (95% CI: 0.02 to 0.24; P = 0.02) for each 5-unit increase in SDI during the previous 12 months. Every 10 mg/m2 increase in average daily GC dose (prednisone equivalent) in the previous 12 months was associated with a height z score decrement of 0.26 (95% CI: 0.20 to 0.32; P < 0.01).

Conclusions: GC likely plays a major role in the observed height decline during therapy for ALL. Because only a minority of children had VF, fractures could not have contributed significantly to the height deficit in the entire cohort but may have been important among the subset with VF.

Authors
Jinhui Ma, Kerry Siminoski, Nathalie Alos, Jacqueline Halton, Josephine Ho, Elizabeth Cummings, Nazih Shenouda, Mary Matzinger, Brian Lentle, Jacob Jaremko, Beverly Wilson, David Stephure, Robert Stein, Anne Sbrocchi, Celia Rodd, Victor Lewis, Caroline Laverdière, Sara Israels, Ronald Grant, Conrad Fernandez, David Dix, Robert Couch, Elizabeth Cairney, Ronald Barr, Stephanie Atkinson, Sharon Abish, David Moher, Frank Rauch, Leanne Ward
Relevant Conditions

Leukemia

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