Impact of Vertebral Fractures and Glucocorticoid Exposure on Height Deficits in Children During Treatment of Leukemia Academic Article uri icon

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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

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

publication date

  • February 1, 2019

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